Basic Information
| Provider Information | |||||||||
| NPI: | 1376989806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARG | ||||||||
| FirstName: | SANDEEP | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D., M.S., B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7606 SWINKS CT | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221022159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039669178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574467934 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2013 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | ME139301 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | ME139301 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.