# CENTER FOR VEIN RESTORATION MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336961648
- **Authorized official:** LORENA THOMAS (CREDENTIALING MANAGER)
- **Authorized official phone:** (815) 254-1761

## Contact information

- **Practice address:** 1160 VARNUM ST NE STE 212, WASHINGTON, DC 20017-2106
- **Practice address phone:** (855) 830-8346
- **Practice address fax:** (240) 473-4321
- **Mailing address:** 7474 GREENWAY CENTER DR STE 1000, GREENBELT, MD 20770-3500
- **Mailing address phone:** (815) 254-1761
- **Mailing address fax:** (240) 473-4321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/28/2024
- **Last updated:** 10/28/2024