Healthcare Provider Details

I. General information

NPI: 1801332804
Provider Name (Legal Business Name): WASHINGTON VASCULAR SPECIALISTS OF FREDERICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD SUITE 325
ROCKVILLE MD
20850-3222
US

IV. Provider business mailing address

75 THOMAS JOHNSON DR SUITE 1
FREDERICK MD
21702-4895
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 Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD42222
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberD42222
License Number StateMD

VIII. Authorized Official

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