Provider Demographics
NPI:1326678731
Name:NOVA VASCULAR SPECIALISTS, LLC
Entity Type:Organization
Organization Name:NOVA VASCULAR SPECIALISTS, LLC
Other - Org Name:OMNI VASCULAR AND DIABETES WOUND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-750-2355
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-0756
Mailing Address - Country:US
Mailing Address - Phone:443-267-4955
Mailing Address - Fax:410-847-2316
Practice Address - Street 1:34 N PHILADELPHIA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2511
Practice Address - Country:US
Practice Address - Phone:443-610-2824
Practice Address - Fax:410-847-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty