Provider Demographics
NPI:1538269923
Name:CHESAPEAKE VEIN CLINIC, LLC
Entity type:Organization
Organization Name:CHESAPEAKE VEIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETROPAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-595-2811
Mailing Address - Street 1:301 STEEPLE CHASE DR STE 404
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4051
Mailing Address - Country:US
Mailing Address - Phone:410-535-1865
Mailing Address - Fax:410-535-9248
Practice Address - Street 1:301 STEEPLE CHASE DR STE 404
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4051
Practice Address - Country:US
Practice Address - Phone:410-535-1865
Practice Address - Fax:410-535-9248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00457572086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG98307Medicare UPIN
MD345PMedicare PIN