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General NPI Number Information
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NPI Number | 1043294200
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Entity Type | Organization
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Legal Business Name | BT HEART AND VASCULAR CENTER, PLLC
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 694 RIVERSIDE DR
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City | MOUNT AIRY
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State | NC
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Zip | 27030-3117
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Country | US
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Telephone | 336-719-7892
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Fax | 336-719-6870
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Provider Business Mailing Address
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Address Line | 694 RIVERSIDE DR
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City | MOUNT AIRY
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State | NC
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Zip | 27030-3117
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Country | US
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Telephone | 336-719-7892
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Fax | 336-719-6870
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Authorized Official
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Title or Position | MANAGER
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Name | BEHZAD TAGHIZADEH
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Credential | MD
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Telephone | 336-765-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 124240
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License Number State | NC
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