Organization
VASCULAR SPECIALTY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN DEIBEL (EXECUTIVE VICE PRESIDENT & CFO)
(410) 659-2905
Entity
Organization
Contact information
Practice address
301 SAINT PAUL PL, 5TH FLOOR, BALTIMORE, MD 21202-2102
(410) 332-9404
(410) 347-5599
Mailing address
PO BOX 824173, PHILADELPHIA, PA 19182-4173
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
551400201
—
MD
01
—
E567
BLUE CHOICE
MD
01
—
KF79LU
BC/BS OF MD
MD
Enumeration date
06/01/2006
Last updated
01/02/2025
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