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General NPI Number Information
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NPI Number | 1255901450
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Entity Type | Organization
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Legal Business Name | USA VASCULAR CENTER OF CHANTILLY LLC
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 5860 COLUMBIA PIKE STE 105A
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City | FALLS CHURCH
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State | VA
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Zip | 22041-2047
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Country | US
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Telephone | 847-593-8460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 971
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City | NORTHBROOK
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State | IL
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Zip | 60065-0971
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Country | US
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Telephone | 847-593-8460
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YAN KATSNELSON
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Credential | MD
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Telephone | 847-593-8460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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