Provider Demographics
NPI:1740580273
Name:GENERAL VASCULAR AND TRANSPLANT CONSULTANTS OF VIRGINIA LLC
Entity Type:Organization
Organization Name:GENERAL VASCULAR AND TRANSPLANT CONSULTANTS OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ-PICON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-968-4435
Mailing Address - Street 1:7611 FOREST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4946
Mailing Address - Country:US
Mailing Address - Phone:804-968-4435
Mailing Address - Fax:804-968-4463
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-968-4435
Practice Address - Fax:804-968-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA104103OtherGROUP PTAN