Provider Demographics
NPI:1881015436
Name:VISTA HEART & VASCULAR, PLLC
Entity Type:Organization
Organization Name:VISTA HEART & VASCULAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-739-9953
Mailing Address - Street 1:PO BOX 3339
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3339
Mailing Address - Country:US
Mailing Address - Phone:855-739-9953
Mailing Address - Fax:571-659-9445
Practice Address - Street 1:4004 GENESEE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8303
Practice Address - Country:US
Practice Address - Phone:855-739-9953
Practice Address - Fax:571-659-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101250434207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty