Provider Demographics
NPI:1992132807
Name:ADVANCED VASCULAR RESOURCES OF JOHNSTOWN LLC
Entity type:Organization
Organization Name:ADVANCED VASCULAR RESOURCES OF JOHNSTOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:HADEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-619-0945
Mailing Address - Street 1:20032 NORTHVILLE HILLS TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7020
Mailing Address - Country:US
Mailing Address - Phone:703-994-6655
Mailing Address - Fax:571-291-2752
Practice Address - Street 1:1027 BROAD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2437
Practice Address - Country:US
Practice Address - Phone:814-619-0945
Practice Address - Fax:855-341-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073567L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty