Provider Demographics
NPI:1063502169
Name:VASCULAR ASSOCIATES OF NORTHERN VIRGINIA PC
Entity type:Organization
Organization Name:VASCULAR ASSOCIATES OF NORTHERN VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PODOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-709-7610
Mailing Address - Street 1:1760 RESTON PARKWAY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3359
Mailing Address - Country:US
Mailing Address - Phone:703-709-7610
Mailing Address - Fax:703-709-7988
Practice Address - Street 1:1760 RESTON PARKWAY
Practice Address - Street 2:SUITE 306
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3359
Practice Address - Country:US
Practice Address - Phone:703-709-7610
Practice Address - Fax:703-709-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010550002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00702Medicare PIN