Provider Demographics
NPI:1033530092
Name:CAROLINA VEIN ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CAROLINA VEIN ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-798-7251
Mailing Address - Street 1:206 JOE V. KNOX AVENUE
Mailing Address - Street 2:SUITE H
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7912
Mailing Address - Country:US
Mailing Address - Phone:704-798-7251
Mailing Address - Fax:
Practice Address - Street 1:206 JOE V. KNOX AVENUE
Practice Address - Street 2:SUITE H
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7912
Practice Address - Country:US
Practice Address - Phone:704-798-7251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty