1093688087 NPI number — VASCULAR SPECIALTY SERVICES, LLC

Table of content: (NPI 1093688087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093688087 NPI number — VASCULAR SPECIALTY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR SPECIALTY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093688087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 ST PAUL PLACE
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21202-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-659-2963
Provider Business Mailing Address Fax Number:
410-332-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9404
Provider Business Practice Location Address Fax Number:
410-347-5599
Provider Enumeration Date:
09/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DEIBEL
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT/CFO
Authorized Official Telephone Number:
410-659-2905

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com