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General NPI Number Information
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NPI Number | 1174363543
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Entity Type | Organization
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Legal Business Name | MEDSTAR ENDOSCOPY CENTER VIRGINIA, LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 6862 ELM ST STE 740
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City | MC LEAN
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State | VA
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Zip | 22101-3862
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Country | US
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Telephone | 571-867-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 10980 GRANTCHESTER WAY FL 7
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City | COLUMBIA
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State | MD
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Zip | 21044-6097
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Country | US
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Telephone | 571-867-0712
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Fax |
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Authorized Official
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Title or Position | PRES. MEDSTAR AMBULATORY SERVICES
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Name | MR. ARTUR SIVASLIAN
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Credential |
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Telephone | 410-772-6696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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