Healthcare Provider Details

I. General information

NPI: 1558624775
Provider Name (Legal Business Name): VIRGINIA VASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1756
US

IV. Provider business mailing address

3620 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1756
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-8640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOMAYOUN HASHEMI
Title or Position: PRESIDENT
Credential:
Phone: 703-359-8640