Basic Information
| Provider Information | |||||||||
| NPI: | 1043648363 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POLARIS HEART & VASCULAR PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4004 GENESEE PL | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221928303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557399953 | ||||||||
| FaxNumber: | 5716599445 | ||||||||
| Practice Location | |||||||||
| Address1: | 4004 GENESEE PL | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221928303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557399953 | ||||||||
| FaxNumber: | 5716599445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | BERENJI | ||||||||
| AuthorizedOfficialFirstName: | KAMBEEZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8557399953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.