Healthcare Provider Details

I. General information

NPI: 1821444902
Provider Name (Legal Business Name): ATLANTIS VASCULAR RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 101
HAGERSTOWN MD
21742-6711
US

IV. Provider business mailing address

15245 SHADY GROVE RD STE 325
ROCKVILLE MD
20850-6280
US

V. Phone/Fax

Practice location:
  • Phone: 240-329-0999
  • Fax: 240-329-2755
Mailing address:
  • Phone: 301-434-0050
  • Fax: 301-448-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0042222
License Number StateMD

VIII. Authorized Official

Name: MUBASHAR A CHOUDRY
Title or Position: OWNER
Credential: MD
Phone: 301-891-2500