Provider Demographics
NPI:1841867900
Name:CENTER FOR VASCULAR MEDICINE FL PLLC
Entity type:Organization
Organization Name:CENTER FOR VASCULAR MEDICINE FL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEF 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:301-981-2000
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:301-982-2000
Mailing Address - Fax:301-982-2001
Practice Address - Street 1:13782 PLANTATION RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:301-982-2000
Practice Address - Fax:301-982-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty