Provider Demographics
NPI:1356789010
Name:DOMINION HEART AND VASCULAR CLINIC
Entity type:Organization
Organization Name:DOMINION HEART AND VASCULAR CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAQUIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-833-8048
Mailing Address - Street 1:PO BOX 11393
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1393
Mailing Address - Country:US
Mailing Address - Phone:804-621-7262
Mailing Address - Fax:877-840-9785
Practice Address - Street 1:563 SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-621-7262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235808207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty