Healthcare Provider Details

I. General information

NPI: 1730320656
Provider Name (Legal Business Name): HEART AND VASCULAR SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE CT SUITE # 215
ASHBURN VA
20147-6213
US

IV. Provider business mailing address

21785 FILIGREE CT SUITE # 215
ASHBURN VA
20147-6213
US

V. Phone/Fax

Practice location:
  • Phone: 609-696-0049
  • Fax:
Mailing address:
  • Phone: 732-231-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101243778
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101243778
License Number StateVA

VIII. Authorized Official

Name: ATHER ANIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 609-969-0049