Modern Vein Providers, PLLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

MODERN VEIN PROVIDERS, PLLC

Practice address

903 Hartford Tpke
Waterford, CT 06385-4264

Phone

(860) 574-3423

Fax

(860) 222-9082

NPI assigned

Jan 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jiyong Ahn, MD

Title

Doctor

Phone

(860) 574-3423

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prashanth Atluri, M.D

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1275847949
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1346010527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 HARTFORD TPKE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854264",
            "telephone_number": "860-574-3423",
            "fax_number": "860-222-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 HARTFORD TPKE",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063854264",
            "telephone_number": "860-574-3423",
            "fax_number": "860-222-9082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN VEIN PROVIDERS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "AHN",
        "authorized_official_first_name": "JIYONG",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "860-574-3423",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalie Menders
• Mark Mikkelson, R.PH.
• Peter Milstein, M.D.
• Francis Gervan Mlynarski, M.D.
• Modern Dental Arts
• Stephanie Diane Moore, PSY.D.
• Thomas A Moran
• Ursula Moreshead, LCSW
• Deborah A Morgan, LPC
• Moxie Therapy LLC

• Vascular & Interventional Radiology Physician in Waterford, CT
• Providers in Waterford, CT by specialty
• Vascular & Interventional Radiology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.