Basic Information
| Provider Information | |||||||||
| NPI: | 1992132807 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED VASCULAR RESOURCES OF JOHNSTOWN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20032 NORTHVILLE HILLS TER | ||||||||
| Address2: | |||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201477020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039946655 | ||||||||
| FaxNumber: | 5712912752 | ||||||||
| Practice Location | |||||||||
| Address1: | 1027 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159062437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146190945 | ||||||||
| FaxNumber: | 8553410781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2013 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | HADEED | ||||||||
| AuthorizedOfficialFirstName: | SAMIR | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8146190945 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | MD073567L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.