NPIMap

Organization Active NPI

Vascular Specialty Services, LLC

  • Vascular Surgery Physician
  • Ellicott City, MD
National Provider Identifier
1902779994
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
VASCULAR SPECIALTY SERVICES, LLC
Practice address
3290 N Ridge Rd Ste 220
Ellicott City, MD 21043-3657
Phone
(410) 332-9404
Fax
(410) 347-5599
NPI assigned
Sep 25, 2025
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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

Authorized official

Name
Justin Deibel
Title
Executive Vice President/Cfo
Phone
(410) 659-2905

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X NU
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

3290 N Ridge Rd Ste 220
Ellicott City, MD 21043-3657

Mailing address

301 St Paul Place
Medical Staff Office
Baltimore, MD 21202-2102
Phone (410) 659-2963

Other names 1

  • Vascular Ellicott City Other name

National Provider Directory

National Provider Directory
Tax ID family
Vascular at Glen Burnie7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1758758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1902779994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 ST PAUL PLACE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212022102",
            "telephone_number": "410-659-2963",
            "fax_number": "410-332-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 N RIDGE RD STE 220",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433657",
            "telephone_number": "410-332-9404",
            "fax_number": "410-347-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR SPECIALTY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-24",
        "status": "A",
        "authorized_official_last_name": "DEIBEL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "410-659-2905"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vascular Ellicott City",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.