Provider Demographics
NPI:1790366714
Name:WOODLANDS VEIN CENTER & PREVENTATIVE MEDICINE CLINIC
Entity Type:Organization
Organization Name:WOODLANDS VEIN CENTER & PREVENTATIVE MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARINDAM
Authorized Official - Middle Name:MOHON
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-795-3386
Mailing Address - Street 1:150 PINE FOREST DR STE 703
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5317
Mailing Address - Country:US
Mailing Address - Phone:281-795-3386
Mailing Address - Fax:
Practice Address - Street 1:150 PINE FOREST DR STE 703
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5317
Practice Address - Country:US
Practice Address - Phone:281-939-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center