Healthcare Provider Details

I. General information

NPI: 1003366618
Provider Name (Legal Business Name): BLUEFIELD VASCULAR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LEATHERWOOD LN
BLUEFIELD VA
24605-2047
US

IV. Provider business mailing address

PO BOX 1557
BLUEFIELD WV
24701-1557
US

V. Phone/Fax

Practice location:
  • Phone: 304-582-0888
  • Fax: 304-582-0877
Mailing address:
  • Phone: 276-582-0888
  • Fax: 276-582-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMAN VARDAN
Title or Position: OWNER
Credential: M.D.
Phone: 276-582-0888