Provider Demographics
NPI:1134779093
Name:MID-ATLANTIC VEIN AND VASCULAR INSTITUTE LLC
Entity type:Organization
Organization Name:MID-ATLANTIC VEIN AND VASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBIZEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-252-6408
Mailing Address - Street 1:5600 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3232
Mailing Address - Country:US
Mailing Address - Phone:267-252-6408
Mailing Address - Fax:
Practice Address - Street 1:5600 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3232
Practice Address - Country:US
Practice Address - Phone:267-252-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical