Healthcare Provider Details

I. General information

NPI: 1215756838
Provider Name (Legal Business Name): VIG MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 RUGBY AVE
BETHESDA MD
20814-3018
US

IV. Provider business mailing address

4849 RUGBY AVE
BETHESDA MD
20814-3018
US

V. Phone/Fax

Practice location:
  • Phone: 800-577-1264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX BEREZIN
Title or Position: MANAGER
Credential:
Phone: 443-929-1478