MEDICARE: VESTA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	14368	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	949L	OTHER	MD	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609356575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VESTA, INC.

Provider Business Mailing Address
First Line	:	9301 ANNAPOLIS RD STE 300
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3125
Country	:	US
Telephone Number	:	240-296-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 INDUSTRIAL PARK DR STE A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2792
Country	:	US
Telephone Number	:	240-296-6030
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JIGNESH DALAL
Credential	:	CPA
Telephone Number	:	240-296-6099

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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Directions to “VESTA, INC. ” Practice Location

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