Provider Demographics
NPI:1114198033
Name:SANJEEV M. WASAN, M.D., PLC
Entity Type:Organization
Organization Name:SANJEEV M. WASAN, M.D., PLC
Other - Org Name:GASTROENTEROLOGY AND HEPATOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-444-9502
Mailing Address - Street 1:46090 LAKE CENTER PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5876
Mailing Address - Country:US
Mailing Address - Phone:703-444-9502
Mailing Address - Fax:703-444-9521
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:703-444-9502
Practice Address - Fax:703-444-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10502Medicare PIN