Provider Demographics
NPI:1891975470
Name:METRO VASCULAR, P.C.
Entity Type:Organization
Organization Name:METRO VASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDSTEIN, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-292-5938
Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-292-5938
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD STE 210
Practice Address - Street 2:SUITE 210
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6132
Practice Address - Country:US
Practice Address - Phone:404-292-5938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018771173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1395Medicare PIN