Provider Demographics
NPI:1720204936
Name:CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.
Entity Type:Organization
Organization Name:CARDIAC AND VASCULAR CARE OF VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-0800
Mailing Address - Street 1:3301 WOODBURN ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6890
Mailing Address - Country:US
Mailing Address - Phone:703-573-0800
Mailing Address - Fax:703-573-8809
Practice Address - Street 1:3301 WOODBURN ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6890
Practice Address - Country:US
Practice Address - Phone:703-573-0800
Practice Address - Fax:703-573-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052912207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01562Medicare PIN