Provider Demographics
NPI:1922163286
Name:CARDIOLOGY CONSULTANTS OF DANVILLE
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF DANVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:MUSTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-791-1088
Mailing Address - Street 1:158 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4100
Mailing Address - Country:US
Mailing Address - Phone:434-791-1088
Mailing Address - Fax:434-799-8525
Practice Address - Street 1:158 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4100
Practice Address - Country:US
Practice Address - Phone:434-791-1088
Practice Address - Fax:434-799-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACC4063OtherRAILROAD MEDICARE
NC890158EMedicaid
VA06058Medicare PIN