Healthcare Provider Details

I. General information

NPI: 1609195585
Provider Name (Legal Business Name): METROPOLITAN VASCULAR ACCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 408
WASHINGTON DC
20010-2989
US

IV. Provider business mailing address

5139 BRAWNER PL
ALEXANDRIA VA
22304-8705
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-5007
  • Fax: 410-721-6363
Mailing address:
  • Phone: 202-877-5007
  • Fax: 410-721-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD035947
License Number StateDC

VIII. Authorized Official

Name: DR. JESSE PATRICK GARCIA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 202-877-5007