1174345482 NPI number — CENTER FOR VEIN RESTORATION MD LLC

Table of content: DR. BRETT EVERETTE WEEDON DDS (NPI 1164666905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174345482 NPI number — CENTER FOR VEIN RESTORATION MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR VEIN RESTORATION MD 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:
1174345482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7474 GREENWAY CENTER DR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-254-1761
Provider Business Mailing Address Fax Number:
240-473-4321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10750 COLUMBIA PIKE STE 605
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20901-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-830-8346
Provider Business Practice Location Address Fax Number:
240-473-4321
Provider Enumeration Date:
10/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
LORENA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
815-254-1761

Provider Taxonomy Codes

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

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





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