Provider Demographics
NPI:1316222177
Name:VEIN HEALTH CENTER OF MARYLAND
Entity Type:Organization
Organization Name:VEIN HEALTH CENTER OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-280-0255
Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-686-8555
Mailing Address - Fax:301-593-9055
Practice Address - Street 1:12013 BROAD MEADOW LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1258
Practice Address - Country:US
Practice Address - Phone:443-253-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052861202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
490747OtherMEDICARE PTAN
490747OtherMEDICARE PTAN