Provider Demographics
NPI:1922195148
Name:WASHINGTON VASCULAR AND THORACIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WASHINGTON VASCULAR AND THORACIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-882-3459
Mailing Address - Street 1:8725 LOCH RAVEN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2227
Mailing Address - Country:US
Mailing Address - Phone:410-882-3459
Mailing Address - Fax:410-882-3310
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 3150 NORTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:410-882-3459
Practice Address - Fax:410-882-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018109400Medicaid
MD600100900Medicaid
DC018109400Medicaid