Provider Demographics
NPI:1356790497
Name:VESPER MEDICAL ASSOCIATES OF VIRGINIA
Entity type:Organization
Organization Name:VESPER MEDICAL ASSOCIATES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE, MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILAD
Authorized Official - Middle Name:LALI
Authorized Official - Last Name:POORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-805-1822
Mailing Address - Street 1:8408 ADLER CT
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24440 STONE SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:571-349-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty