Organization
VIV FAIRFAX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANISH P SHAH MD (CEO)
(215) 828-2387
Entity
Organization
Contact information
Practice address
13135 LEE JACKSON MEMORIAL HWY STE 145, FAIRFAX, VA 22033-1907
(215) 828-2387
Mailing address
14085 CROWN CT, WOODBRIDGE, VA 22193-1458
(703) 763-5224
(703) 763-5374
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
—
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
04/22/2021
Last updated
04/22/2021
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