Healthcare Provider Details

I. General information

NPI: 1497618169
Provider Name (Legal Business Name): METROPOLITAN VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37767 MARKET DR
CHARLOTTE HALL MD
20622-3188
US

IV. Provider business mailing address

14085 CROWN CT
WOODBRIDGE VA
22193-1458
US

V. Phone/Fax

Practice location:
  • Phone: 301-374-8540
  • Fax: 301-374-8541
Mailing address:
  • Phone: 703-763-5224
  • Fax: 703-763-5374

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: ANISH P SHAH
Title or Position: CEO
Credential: MD
Phone: 703-763-5224