Healthcare Provider Details

I. General information

NPI: 1356790497
Provider Name (Legal Business Name): VESPER MEDICAL ASSOCIATES OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24440 STONE SPRINGS BLVD
DULLES VA
20166
US

IV. Provider business mailing address

8408 ADLER CT
MILLERSVILLE MD
21108-1771
US

V. Phone/Fax

Practice location:
  • Phone: 571-349-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MILAD LALI POORAN
Title or Position: PRINCIPLE, MANAGING PARTNER
Credential: M.D.
Phone: 202-805-1822