Provider Demographics
NPI:1871187245
Name:METROPOLITAN VASCULAR INSTITUTE LLC
Entity Type:Organization
Organization Name:METROPOLITAN VASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-763-5224
Mailing Address - Street 1:14085 CROWN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1458
Mailing Address - Country:US
Mailing Address - Phone:703-763-5224
Mailing Address - Fax:703-763-5374
Practice Address - Street 1:3015 TECHNOLOGY PLACE SUITE 110
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-374-8540
Practice Address - Fax:301-374-8541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN VASCULAR INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty