Provider Demographics
NPI:1669455143
Name:BT HEART AND VASCULAR CENTER, PLLC
Entity type:Organization
Organization Name:BT HEART AND VASCULAR CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-2500
Mailing Address - Street 1:812 W STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2605
Mailing Address - Country:US
Mailing Address - Phone:276-238-3318
Mailing Address - Fax:276-239-4204
Practice Address - Street 1:812 W STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2605
Practice Address - Country:US
Practice Address - Phone:276-238-3318
Practice Address - Fax:276-239-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA116217OtherAETNA
VA249989OtherSOUTHERN HEALTH
VADC6368OtherMEDICARE RR
VA116217OtherAETNA
VAC09298Medicare PIN