Healthcare Provider Details

I. General information

NPI: 1962323378
Provider Name (Legal Business Name): VIDAVASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 BRANDON AVE STE 216
SPRINGFIELD VA
22150-2504
US

IV. Provider business mailing address

6120 BRANDON AVE STE 216
SPRINGFIELD VA
22150-2504
US

V. Phone/Fax

Practice location:
  • Phone: 866-800-2346
  • Fax:
Mailing address:
  • Phone: 866-800-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MEGHAL ANTANI
Title or Position: MEDICAL DIRECTOR
Credential: MD, MBA
Phone: 866-800-2346