Healthcare Provider Details

I. General information

NPI: 1598950644
Provider Name (Legal Business Name): AMIT SURENDRA VASHIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR FOURTH FLOOR
ABINGDON VA
24211-7659
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR FL 4
ABINGDON VA
24211-7664
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-4050
  • Fax: 276-258-4056
Mailing address:
  • Phone: 276-258-4050
  • Fax: 276-258-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47570
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47570
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47570
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101251218
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101251218
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101251218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: