Provider Demographics
NPI:1235456757
Name:METROPOLITAN CARDIAC SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:METROPOLITAN CARDIAC SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-309-1880
Mailing Address - Street 1:4123 N RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5803
Mailing Address - Country:US
Mailing Address - Phone:202-309-1880
Mailing Address - Fax:
Practice Address - Street 1:4123 N RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5803
Practice Address - Country:US
Practice Address - Phone:202-309-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30329208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33533OtherUPIN
1659395739OtherINDIVIDUAL NPI