Provider Demographics
NPI:1760457691
Name:CARDIAC DIAGNOSTIC SERVICES OF VA
Entity Type:Organization
Organization Name:CARDIAC DIAGNOSTIC SERVICES OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMARTE
Authorized Official - Suffix:
Authorized Official - Credentials:RSO CEO
Authorized Official - Phone:703-641-0500
Mailing Address - Street 1:8505 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4644
Mailing Address - Country:US
Mailing Address - Phone:703-641-0500
Mailing Address - Fax:703-204-9056
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4644
Practice Address - Country:US
Practice Address - Phone:703-641-0500
Practice Address - Fax:703-204-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA07005207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
169535Medicare ID - Type Unspecified