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Organization
MODERN VASCULAR OF FAIRFAX, LLC
Active
Organization
MODERN VASCULAR OF FAIRFAX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YURY GAMPEL (MANAGER)
(818) 880-8605
Entity
Organization
Contact information
Practice address
2812 OLD LEE HWY STE 100B, FAIRFAX, VA 22031-4315
(571) 279-6849
(571) 281-8697
Mailing address
26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
(818) 880-8605
(818) 579-7916
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
2471V0106X
Vascular-Interventional Technology Radiologic Technologist
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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