Healthcare Provider Details

I. General information

NPI: 1538466008
Provider Name (Legal Business Name): VASCULAR SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 WILLIAMS DRIVE SUITE 100
FAIRFAX VA
22031
US

IV. Provider business mailing address

3022 WILLIAMS DRIVE SUITE 100
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-917-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101232663
License Number StateVA

VIII. Authorized Official

Name: DR. HOMAYOUN HASHEMI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-917-0377