Provider Demographics
NPI:1114971918
Name:CARDIOVASCULAR ASSOCIATES LTD
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DONLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-499-2825
Mailing Address - Street 1:5700 CLEVELAND STREET
Mailing Address - Street 2:SUITE 228
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1752
Mailing Address - Country:US
Mailing Address - Phone:757-499-2825
Mailing Address - Fax:757-499-4248
Practice Address - Street 1:612 KINGSBOROUGH SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5041
Practice Address - Country:US
Practice Address - Phone:757-547-9294
Practice Address - Fax:757-213-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA054960OtherANTHEM BCBS
NC01878OtherBCBS
VA054961OtherANTHEM BCBS
VA1114971918Medicaid
VA053609OtherANTHEM BCBS
NC8901878Medicaid
VA054961OtherANTHEM BCBS
NC8901878Medicaid