Provider Demographics
NPI:1407830672
Name:BT HEART AND VASCULAR CENTER, PLLC
Entity Type:Organization
Organization Name:BT HEART AND VASCULAR CENTER, PLLC
Other - Org Name:THE HEART AND VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-2500
Mailing Address - Street 1:110 EAST BLUE RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1560
Mailing Address - Country:US
Mailing Address - Phone:276-692-2540
Mailing Address - Fax:336-719-7898
Practice Address - Street 1:110 EAST BLUE RIDGE ST.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1560
Practice Address - Country:US
Practice Address - Phone:276-692-2540
Practice Address - Fax:276-694-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116217OtherAETNA
VA249989OtherSOUTHERN HEALTH
VADC09298OtherMEDICARE RR
VAC09298Medicare PIN
VADC09298OtherMEDICARE RR