Provider Demographics
NPI:1942509989
Name:VASCULAR INSTITUTE OF VIRGINIA LLC
Entity Type:Organization
Organization Name:VASCULAR INSTITUTE OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANISH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FASN
Authorized Official - Phone:215-828-2387
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 1:14085 CROWN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1458
Practice Address - Country:US
Practice Address - Phone:703-763-5224
Practice Address - Fax:703-763-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD312008200Medicaid
VA1942509989Medicaid
VA1942509989Medicaid