Provider Demographics
NPI:1164952446
Name:CARDINAL HEART & VASCULAR, PLLC
Entity type:Organization
Organization Name:CARDINAL HEART & VASCULAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURIYA
Authorized Official - Middle Name:BANDARA
Authorized Official - Last Name:JAYAWARDENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC,FSCAI
Authorized Official - Phone:919-718-0102
Mailing Address - Street 1:2609 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8032
Mailing Address - Country:US
Mailing Address - Phone:919-718-0102
Mailing Address - Fax:919-718-0280
Practice Address - Street 1:2609 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-8032
Practice Address - Country:US
Practice Address - Phone:919-718-0102
Practice Address - Fax:919-718-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty