Healthcare Provider Details

I. General information

NPI: 1700480563
Provider Name (Legal Business Name): WASHINGTON VASCULAR SERVICES AND MANAGEMENT PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14343 SE 92ND ST
NEWCASTLE WA
98059-3477
US

IV. Provider business mailing address

14343 SE 92ND ST
NEWCASTLE WA
98059-3477
US

V. Phone/Fax

Practice location:
  • Phone: 314-323-2727
  • Fax:
Mailing address:
  • Phone: 314-323-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUMEET SUBHERWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 314-323-2727