Healthcare Provider Details

I. General information

NPI: 1356774731
Provider Name (Legal Business Name): WASHINGTON VASCULAR INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD SUITE 100
HAGERSTOWN MD
21742-6700
US

IV. Provider business mailing address

7610 CARROLL AVE SUITE 100
TAKOMA PARK MD
20912-6384
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-2500
  • Fax: 301-448-1679
Mailing address:
  • Phone: 301-891-2500
  • Fax: 301-448-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MUBASHAR A. CHOUDRY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-891-2500