Provider Demographics
NPI:1285493650
Name:WASHINGTON VASCULAR SPECIALISTS OF FAIRFAX
Entity type:Organization
Organization Name:WASHINGTON VASCULAR SPECIALISTS OF FAIRFAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUBASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-596-3800
Mailing Address - Street 1:2812 OLD LEE HWY STE 100B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4315
Mailing Address - Country:US
Mailing Address - Phone:703-596-3800
Mailing Address - Fax:703-596-3700
Practice Address - Street 1:2812 OLD LEE HWY STE 100B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4315
Practice Address - Country:US
Practice Address - Phone:703-596-3800
Practice Address - Fax:703-596-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical