Healthcare Provider Details

I. General information

NPI: 1700794864
Provider Name (Legal Business Name): HEART AND VASCULAR GROUP ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 EDWIN DR STE 101
VIRGINIA BEACH VA
23462-4548
US

IV. Provider business mailing address

389 EDWIN DR STE 101
VIRGINIA BEACH VA
23462-4548
US

V. Phone/Fax

Practice location:
  • Phone: 757-963-7729
  • Fax:
Mailing address:
  • Phone: 757-963-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GEN
Title or Position: DOCTOR
Credential: MD
Phone: 757-963-7729