Provider Demographics
NPI:1124225057
Name:VEIN SPECIALISTS OF NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:VEIN SPECIALISTS OF NORTH CAROLINA, PA
Other - Org Name:KAMRAN GOUDARZI, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-725-2737
Mailing Address - Street 1:2015 SPRING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3944
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:
Practice Address - Street 1:6752 ROCK SPRING ROAD
Practice Address - Street 2:SUITE #200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405
Practice Address - Country:US
Practice Address - Phone:910-798-5347
Practice Address - Fax:910-763-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDC3861OtherRAILROAD MEDICARE PIN
NC2333009OtherMEDICARE PIN
NCDC3861OtherRAILROAD MEDICARE PIN
NC2333009Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NCB82769Medicare UPIN