Healthcare Provider Details

I. General information

NPI: 1053514372
Provider Name (Legal Business Name): AMELIA HEART AND VASCULAR CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

IV. Provider business mailing address

6136 BRANDON AVE
SPRINGFIELD VA
22150-2610
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-3131
  • Fax: 703-866-3133
Mailing address:
  • Phone: 703-866-3131
  • Fax: 703-866-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101054906
License Number StateVA

VIII. Authorized Official

Name: DR. NAGHMEH TEBYANIAN
Title or Position: CARDIOLOGIST
Credential: M.D.
Phone: 703-866-3131