Provider Demographics
NPI:1487843868
Name:CARDIOVASCULAR IMAGING, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-654-0591
Mailing Address - Street 1:5530 WISCONSIN AVE STE 915
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4330
Mailing Address - Country:US
Mailing Address - Phone:410-666-8526
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE STE 915
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4330
Practice Address - Country:US
Practice Address - Phone:301-654-0591
Practice Address - Fax:301-654-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14718293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FDCV02Medicare PIN