Organization
MIVC ASC, LLC
Active
Parent organization
MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND
Authorized official
DR. JEFFERY JARWRI DORMU DO (CEO/VASCULAR SURGEON)
(301) 497-1590
Entity
Organization
Contact information
Practice address
9201 CHERRY LANE, LAUREL, MD 20707
(301) 497-1590
Mailing address
8730 CHERRY LN, SUITE 10, LAUREL, MD 20707-6212
(301) 497-1590
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
10/20/2016
Last updated
11/02/2016
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