1023062825 NPI number — CARDIOVASCULAR ASSOC LTD

Table of content: (NPI 1023062825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023062825 NPI number — CARDIOVASCULAR ASSOC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR ASSOC LTD
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:
1023062825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 CLEVELAND STREET
Provider Second Line Business Mailing Address:
SUITE 228
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-1752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-499-2825
Provider Business Mailing Address Fax Number:
757-213-9361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 OLD DONATION PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-395-5300
Provider Business Practice Location Address Fax Number:
757-213-9356
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DONLON
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
757-499-2825

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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