Provider Demographics
NPI:1205465382
Name:CENTER FOR VASCULAR MEDICINE CT, PLLC
Entity type:Organization
Organization Name:CENTER FOR VASCULAR MEDICINE CT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:301-982-2000
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 900
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3504
Mailing Address - Country:US
Mailing Address - Phone:301-486-4690
Mailing Address - Fax:
Practice Address - Street 1:136 BERLIN RD STE 202
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2622
Practice Address - Country:US
Practice Address - Phone:301-486-4690
Practice Address - Fax:301-982-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR VASCULAR MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty