1720204936 NPI number — CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.

Table of content: JACQUELINE ALICE ROONEY O.D. (NPI 1023090396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720204936 NPI number — CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720204936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 WOODBURN ROAD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003-6890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-573-0800
Provider Business Mailing Address Fax Number:
703-573-8809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 WOODBURN ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-6890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-573-0800
Provider Business Practice Location Address Fax Number:
703-573-8809
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-573-0800

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  0101052912 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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