Healthcare Provider Details

I. General information

NPI: 1407830672
Provider Name (Legal Business Name): BT HEART AND VASCULAR CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EAST BLUE RIDGE ST.
STUART VA
24171-1560
US

IV. Provider business mailing address

110 EAST BLUE RIDGE ST
STUART VA
24171-1560
US

V. Phone/Fax

Practice location:
  • Phone: 276-692-2540
  • Fax: 276-694-4206
Mailing address:
  • Phone: 276-692-2540
  • Fax: 336-719-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BEHZAD TAGHIZADEH
Title or Position: MANAGER
Credential: M.D.
Phone: 336-765-2500