Healthcare Provider Details

I. General information

NPI: 1417968421
Provider Name (Legal Business Name): GREGG A VIGEANT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CARROLL AVENUE WASHINGTON ADVENTIST HOSPITAL
TAKOMA PARK MD
20912
US

IV. Provider business mailing address

1300 PICCARD DR SUITE 202
ROCKVILLE MD
20850-4303
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-5070
  • Fax: 301-891-5132
Mailing address:
  • Phone: 301-921-7900
  • Fax: 301-921-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001663
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: