Healthcare Provider Details

I. General information

NPI: 1902862261
Provider Name (Legal Business Name): AVISESH SAHGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 SUNRISE VALLEY DRIVE, SUITE 120
RESTON VA
20191-3469
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, SUITE 403 STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 571-375-7174
  • Fax: 571-375-7177
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-448-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101234860
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101234860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: