Provider Demographics
NPI:1386900397
Name:MASTER, VIVAK MAHENDRA (MD)
Entity type:Individual
Prefix:
First Name:VIVAK
Middle Name:MAHENDRA
Last Name:MASTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8001 FRANKLIN FARMS DR RM 130
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5100
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:4700 PUDDLEDOCK RD STE 400
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1268
Practice Address - Country:US
Practice Address - Phone:804-458-1740
Practice Address - Fax:804-541-1846
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2020-07-30
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Provider Licenses
StateLicense IDTaxonomies
VA0101259987207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease