Basic Information
| Provider Information | |||||||||
| NPI: | 1992137590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGNUS HEART AND VASCULAR, INC. | ||||||||
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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: | 08/06/2013 | ||||||||
| LastUpdateDate: | 04/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | SIRAK | ||||||||
| AuthorizedOfficialFirstName: | TSEDAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8557399953 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 0101242816 | VA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 0101242816 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.