Advance Vascular Labs
Organization Active NPI Clinic/Center · Greenbelt, MD
NPI 1558085845 · NPPES record last updated Sep 29, 2022
Key facts
- NPI
- 1558085845
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ADVANCE VASCULAR LABS
- Practice address
- 7227 Hanover Pkwy Ste B
Greenbelt, MD 20770-2025 - Phone
- (301) 474-9222
- Fax
- (301) 374-9225
- NPI assigned
- Sep 29, 2022
- Organization subpart
- No
Authorized official
- Name
- Pradeep Srivastava, MD
- Title
- Ceo
- Phone
- (301) 312-1291
Practitioners 1
-
Pradeep Srivastava, MD FA CC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221022000018 | DC | Part B Supplier - Clinic/Group Practice | 8628444288 |
Receives reassigned benefits from 1 practitioner Practice locations: Greenbelt, MD |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | |||
| Clinic/Center | 261Q00000X | Yes | ||
| Ambulatory Surgical Clinic/Center | 261QA1903X |
Addresses
Primary practice location
7227 Hanover Pkwy Ste B
Greenbelt, MD 20770-2025
Mailing address
7227 Hanover Pkwy Ste B
Greenbelt, MD 20770-2025
Phone (301) 474-9222
Other providers in Greenbelt, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.