Provider Demographics
NPI:1992137590
Name:MAGNUS HEART AND VASCULAR, INC.
Entity type:Organization
Organization Name:MAGNUS HEART AND VASCULAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TSEDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-739-9953
Mailing Address - Street 1:4004 GENESEE PL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8303
Mailing Address - Country:US
Mailing Address - Phone:855-739-9953
Mailing Address - Fax:571-659-9445
Practice Address - Street 1:4004 GENESEE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8303
Practice Address - Country:US
Practice Address - Phone:855-739-9953
Practice Address - Fax:571-659-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242816207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty