Provider Demographics
NPI:1588853865
Name:VEIN CENTER OF CHARLOTTE
Entity Type:Organization
Organization Name:VEIN CENTER OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WITTEN
Authorized Official - Last Name:ALTIZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACPH
Authorized Official - Phone:704-341-1122
Mailing Address - Street 1:10502 PARK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8479
Mailing Address - Country:US
Mailing Address - Phone:704-341-1122
Mailing Address - Fax:
Practice Address - Street 1:10502 PARK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8479
Practice Address - Country:US
Practice Address - Phone:704-341-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900407202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty