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General NPI Number Information
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NPI Number | 1093294910
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Entity Type | Organization
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Legal Business Name | METROPOLITAN VASCULAR INSTITUTE LLC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 3015 TECHNOLOGY PLACE SUITE 100
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City | WALDORF
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State | MD
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Zip | 20601
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Country | US
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Telephone | 301-374-8540
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Fax | 301-374-8541
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Provider Business Mailing Address
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Address Line | 14085 CROWN CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1458
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Country | US
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Telephone | 703-763-5224
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Fax | 703-763-5374
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Authorized Official
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Title or Position | M.D.
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Name | ANISH SHAH
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Credential |
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Telephone | 703-763-5224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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