Provider Demographics
NPI:1386441491
Name:DC METROPOLITAN VASCULAR & IR PROCEDURE CENTER LLC
Entity type:Organization
Organization Name:DC METROPOLITAN VASCULAR & IR PROCEDURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LICATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-427-1630
Mailing Address - Street 1:5801 ALLENTOWN RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4653
Mailing Address - Country:US
Mailing Address - Phone:240-427-1630
Mailing Address - Fax:240-492-2070
Practice Address - Street 1:5801 ALLENTOWN RD STE 502
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4653
Practice Address - Country:US
Practice Address - Phone:240-427-1630
Practice Address - Fax:240-492-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical