Healthcare Provider Details

I. General information

NPI: 1871187245
Provider Name (Legal Business Name): METROPOLITAN VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 TECHNOLOGY PLACE SUITE 110
WALDORF MD
20601
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 Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

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