Provider Demographics
NPI:1790832806
Name:WASHINGTON VASCULAR DIAGNOSTICS, INC.
Entity Type:Organization
Organization Name:WASHINGTON VASCULAR DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-796-7036
Mailing Address - Street 1:39300 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2338
Mailing Address - Country:US
Mailing Address - Phone:510-796-7036
Mailing Address - Fax:510-796-7039
Practice Address - Street 1:39300 CIVIC CENTER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2338
Practice Address - Country:US
Practice Address - Phone:510-796-7036
Practice Address - Fax:510-796-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15742ZMedicare ID - Type UnspecifiedPROVIDER NUMBER