Provider Demographics
NPI:1467055152
Name:CHILDRENS CARDIAC CARE LLC
Entity Type:Organization
Organization Name:CHILDRENS CARDIAC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-364-2301
Mailing Address - Street 1:114 BLACKGUM CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2544
Mailing Address - Country:US
Mailing Address - Phone:571-364-2301
Mailing Address - Fax:
Practice Address - Street 1:2002 ORANGE RD STE 201
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4175
Practice Address - Country:US
Practice Address - Phone:540-322-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty