Provider Demographics
NPI:1174614978
Name:VASCULAR LABORATORY OF FAIRFAX, LLC
Entity type:Organization
Organization Name:VASCULAR LABORATORY OF FAIRFAX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMSARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-2400
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-573-2400
Mailing Address - Fax:703-207-9527
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 402
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-573-2400
Practice Address - Fax:703-207-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA516024Medicare PIN