Provider Demographics
NPI:1821444902
Name:ATLANTIS VASCULAR RESOURCES LLC
Entity Type:Organization
Organization Name:ATLANTIS VASCULAR RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBASHAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-2500
Mailing Address - Street 1:15245 SHADY GROVE RD STE 325
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6280
Mailing Address - Country:US
Mailing Address - Phone:301-434-0050
Mailing Address - Fax:301-448-1679
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6711
Practice Address - Country:US
Practice Address - Phone:240-329-0999
Practice Address - Fax:240-329-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty