Organization
CENTER FOR VEIN RESTORATION MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA VERNON (CREDENTIALING MANAGER)
(240) 965-3271
Entity
Organization
Contact information
Practice address
7300 HANOVER DR, SUITE 303, GREENBELT, MD 20770-2202
(240) 965-3271
(240) 473-4326
Mailing address
7474 GREENWAY CENTER DR, SUITE 1000, GREENBELT, MD 20770-3504
(240) 965-3271
(240) 473-4326
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
169600900
—
MD
Enumeration date
03/27/2007
Last updated
12/19/2012
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