Provider Demographics
NPI:1578624102
Name:PRINCE WILLIAM CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PRINCE WILLIAM CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COPPAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-369-5959
Mailing Address - Street 1:8569B SUDLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-369-5959
Mailing Address - Fax:703-369-7473
Practice Address - Street 1:8569B SUDLEY ROAD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-369-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002200929207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21762Medicare UPIN
B60044Medicare UPIN
H25487Medicare UPIN
C01650Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
1821076142Medicare UPIN
VAC01650Medicare PIN
I41323Medicare UPIN
DCG01110Medicare PIN
1841331840Medicare UPIN