Provider Demographics
NPI:1003188376
Name:INTERVENTIONAL, VASCULAR & DIAGNOSTIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:INTERVENTIONAL, VASCULAR & DIAGNOSTIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-4884
Mailing Address - Street 1:PO BOX 301103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-1103
Mailing Address - Country:US
Mailing Address - Phone:713-795-4884
Mailing Address - Fax:713-383-4470
Practice Address - Street 1:16 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7007
Practice Address - Country:US
Practice Address - Phone:713-795-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085N0904X, 2085R0202X
TXK94332085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty