Provider Demographics
NPI:1205072899
Name:VR SUBSIDIARY LLC
Entity type:Organization
Organization Name:VR SUBSIDIARY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-738-3600
Mailing Address - Street 1:411 CRAIN HWY S
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3644
Mailing Address - Country:US
Mailing Address - Phone:410-768-3600
Mailing Address - Fax:410-768-3731
Practice Address - Street 1:411 CRAIN HWY S
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3644
Practice Address - Country:US
Practice Address - Phone:410-768-3600
Practice Address - Fax:410-768-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center