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Contact Information

MODERN VASCULAR OF FAIRFAX, LLC
2812 OLD LEE HWY STE 100B
FAIRFAX, VA22031-4315
 Phone: 571-279-6849
 Fax: 571-281-8697
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
 

Vascular-Interventional Technology Radiologic Technologist

2471V0106X
Indicates primary specialty

NPI Profile & details for MODERN VASCULAR OF FAIRFAX LLC · (Female)

NPI Number 1821553108
Status Active
Credentials
Entity Individual
Enumeration date 01/31/2019
Last updated 01/31/2019 - About 7 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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