Provider Demographics
NPI:1083133144
Name:COMMUNITY CARDIOLOGY
Entity Type:Organization
Organization Name:COMMUNITY CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:AGYEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-490-8773
Mailing Address - Street 1:PO BOX 11768
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0168
Mailing Address - Country:US
Mailing Address - Phone:804-353-4000
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:43 RIVES RD STE 201
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-490-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233334207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101233334OtherMEDICAL LICENSE