Provider Demographics
NPI:1417267980
Name:CVIO DIAGNOSTICS
Entity Type:Organization
Organization Name:CVIO DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUVARCHALA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-480-4445
Mailing Address - Street 1:5540 E GRANT ST
Mailing Address - Street 2:STE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1668
Mailing Address - Country:US
Mailing Address - Phone:407-480-4445
Mailing Address - Fax:407-480-4446
Practice Address - Street 1:5540 E GRANT ST
Practice Address - Street 2:STE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1668
Practice Address - Country:US
Practice Address - Phone:407-480-4445
Practice Address - Fax:407-480-4446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR INSTITUTE OF ORLANDO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA12342Medicare UPIN