Healthcare Provider Details

I. General information

NPI: 1386975795
Provider Name (Legal Business Name): DISTRICT VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 VERMONT AVE NW SUITE 300
WASHINGTON DC
20005-4902
US

IV. Provider business mailing address

PO BOX 38574
PHILADELPHIA PA
19104-8574
US

V. Phone/Fax

Practice location:
  • Phone: 202-824-0620
  • Fax: 202-824-0911
Mailing address:
  • Phone: 215-382-3860
  • Fax: 215-382-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES FREDRICK MCGUCKIN
Title or Position: CEO
Credential: MD
Phone: 215-382-3680