Provider Demographics
NPI:1598966871
Name:CARDIOMED PLLC
Entity Type:Organization
Organization Name:CARDIOMED PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-582-0888
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1557
Mailing Address - Country:US
Mailing Address - Phone:276-582-0888
Mailing Address - Fax:
Practice Address - Street 1:990 LEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2047
Practice Address - Country:US
Practice Address - Phone:276-582-0888
Practice Address - Fax:276-582-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19508261QH0100X
VA0101220759261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0081887000Medicaid
VA005842981Medicaid
VAC11055Medicare PIN
WVF77699Medicare UPIN
VA005842981Medicaid