Provider Demographics
NPI:1619236304
Name:DOMINION CARDIOVASCULAR ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DOMINION CARDIOVASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN ANTHONY
Authorized Official - Middle Name:VENTURA
Authorized Official - Last Name:QUION
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:703-346-6388
Mailing Address - Street 1:PO BOX 5433
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22103-5433
Mailing Address - Country:US
Mailing Address - Phone:703-346-6388
Mailing Address - Fax:
Practice Address - Street 1:12710 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2486
Practice Address - Country:US
Practice Address - Phone:703-496-4190
Practice Address - Fax:866-239-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058310207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00142Medicare UPIN