Healthcare Provider Details

I. General information

NPI: 1841802857
Provider Name (Legal Business Name): USA VASCULAR CENTERS OF DISTRICT OF COLUMBIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 103
WASHINGTON DC
20011-1137
US

IV. Provider business mailing address

PO BOX 1602
NORTHBROOK IL
60065-1602
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax: 224-235-4652
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-235-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: CEO / PRESIDENT
Credential: MD
Phone: 847-774-5300