Basic Information
| Provider Information | |||||||||
| NPI: | 1093091399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR INTERVENTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 16TH ST | ||||||||
| Address2: | #309 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209103240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018074055 | ||||||||
| FaxNumber: | 3015605257 | ||||||||
| Practice Location | |||||||||
| Address1: | 8201 16TH ST | ||||||||
| Address2: | #309 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209103240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018074055 | ||||||||
| FaxNumber: | 3015605257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2011 | ||||||||
| LastUpdateDate: | 10/31/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALFORD | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3018074055 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | D0042931 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 097700400 | 05 | MD | MEDICAID |