NPIMap

Organization Active NPI

Centurion Vascular Care LLC

  • Vascular & Interventional Radiology Physician
  • Lanham, MD
National Provider Identifier
1386200525
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
CENTURION VASCULAR CARE LLC
Practice address
4230 Forbes Blvd Ste E
Lanham, MD 20706-4399
Phone
(571) 282-8699
NPI assigned
May 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Amanuel Fessahaye, MD
Title
Medical Director
Phone
(571) 282-8699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

4230 Forbes Blvd Ste E
Lanham, MD 20706-4399

Mailing address

1111 Wythe St
Alexandria, VA 22314-1842
Phone (571) 282-8699

National Provider Directory

National Provider Directory

Locations

4230 Forbes Blvd
Ste E
Lanham, MD 20706
Phone (301) 577-5535

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1386200525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 WYTHE ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223141842",
            "telephone_number": "571-282-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 FORBES BLVD STE E",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064399",
            "telephone_number": "571-282-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURION VASCULAR CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "FESSAHAYE",
        "authorized_official_first_name": "AMANUEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "571-282-8699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.