Provider Demographics
NPI:1760653448
Name:CENTER FOR INTERVENTIONAL MEDICINE, LLC
Entity Type:Organization
Organization Name:CENTER FOR INTERVENTIONAL MEDICINE, LLC
Other - Org Name:VIDAVASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-800-2346
Mailing Address - Street 1:251 NATIONAL HARBOR BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1052
Mailing Address - Country:US
Mailing Address - Phone:866-800-2346
Mailing Address - Fax:
Practice Address - Street 1:251 NATIONAL HARBOR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1052
Practice Address - Country:US
Practice Address - Phone:866-800-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD133024ZAZLMedicare PIN