Provider Demographics
NPI:1669577979
Name:MARYLAND VEIN PROFESSIONALS, LLC
Entity type:Organization
Organization Name:MARYLAND VEIN PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CALURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-964-8346
Mailing Address - Street 1:6030 MARSHALEE DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075
Mailing Address - Country:US
Mailing Address - Phone:400-964-8346
Mailing Address - Fax:410-964-8350
Practice Address - Street 1:8860 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2195
Practice Address - Country:US
Practice Address - Phone:410-964-8346
Practice Address - Fax:410-964-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050590208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD784323200Medicaid
MDH86939Medicare UPIN
MD784323200Medicaid
MD298P608GMedicare PIN