Provider Demographics
NPI:1053514372
Name:AMELIA HEART AND VASCULAR CENTER, INC.
Entity type:Organization
Organization Name:AMELIA HEART AND VASCULAR CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGHMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBYANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-866-3131
Mailing Address - Street 1:6136 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2610
Mailing Address - Country:US
Mailing Address - Phone:703-866-3131
Mailing Address - Fax:703-866-3133
Practice Address - Street 1:6136 BRANDON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2610
Practice Address - Country:US
Practice Address - Phone:703-866-3131
Practice Address - Fax:703-866-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054906207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH23427Medicare UPIN