Provider Demographics
NPI:1205190626
Name:CENTER FOR VEIN RESTORATION MD LLC
Entity Type:Organization
Organization Name:CENTER FOR VEIN RESTORATION MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-860-0003
Mailing Address - Street 1:7025 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1428
Mailing Address - Country:US
Mailing Address - Phone:703-785-8792
Mailing Address - Fax:
Practice Address - Street 1:7025 GROVE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1428
Practice Address - Country:US
Practice Address - Phone:703-785-8792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty