Provider Demographics
NPI:1609195585
Name:METROPOLITAN VASCULAR ACCESS
Entity Type:Organization
Organization Name:METROPOLITAN VASCULAR ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-877-5007
Mailing Address - Street 1:5139 BRAWNER PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8705
Mailing Address - Country:US
Mailing Address - Phone:202-877-5007
Mailing Address - Fax:410-721-6363
Practice Address - Street 1:106 IRVING ST NW STE 408
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2989
Practice Address - Country:US
Practice Address - Phone:202-877-5007
Practice Address - Fax:410-721-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0359472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD035947OtherLICENSE NUMBER DC