Provider Demographics
NPI:1346503463
Name:MID ATLANTIC VASCULAR HOLDING, LLC
Entity Type:Organization
Organization Name:MID ATLANTIC VASCULAR HOLDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHWARZKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CMPE, MBA
Authorized Official - Phone:757-333-2066
Mailing Address - Street 1:1415 EASTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5501
Mailing Address - Country:US
Mailing Address - Phone:757-333-2066
Mailing Address - Fax:757-467-2703
Practice Address - Street 1:1415 EASTRIDGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5501
Practice Address - Country:US
Practice Address - Phone:757-333-2066
Practice Address - Fax:757-467-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty