Healthcare Provider Details

I. General information

NPI: 1376989806
Provider Name (Legal Business Name): SANDEEP K GARG M.D., M.S., B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE
NORFOLK VA
23507-1914
US

IV. Provider business mailing address

7606 SWINKS CT
MC LEAN VA
22102-2159
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-7934
  • Fax:
Mailing address:
  • Phone: 703-966-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME139301
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME139301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: