Healthcare Provider Details

I. General information

NPI: 1548842370
Provider Name (Legal Business Name): MDWATCH MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10304 EATON PL STE 100
FAIRFAX VA
22030-2221
US

IV. Provider business mailing address

13280 EVENING CREEK DR S STE 225
SAN DIEGO CA
92128-4664
US

V. Phone/Fax

Practice location:
  • Phone: 877-257-0637
  • Fax: 888-355-4954
Mailing address:
  • Phone: 877-257-0637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VISHAL VERMA
Title or Position: CEO
Credential: MD
Phone: 877-257-0637