Provider Demographics
NPI:1942413182
Name:THE VEIN TREATMENT CENTER, PA
Entity type:Organization
Organization Name:THE VEIN TREATMENT CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:919-235-3400
Mailing Address - Street 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6478
Mailing Address - Country:US
Mailing Address - Phone:919-235-3400
Mailing Address - Fax:919-532-2145
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6478
Practice Address - Country:US
Practice Address - Phone:919-235-3400
Practice Address - Fax:919-532-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141018174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty