Healthcare Provider Details

I. General information

NPI: 1467672212
Provider Name (Legal Business Name): VIRGINIA NUCLEAR CARDIOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD SUITE 304
ANNANDALE VA
22003-1229
US

IV. Provider business mailing address

10720 SIKES PL SUITE 300
CHARLOTTE NC
28277-8141
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-0355
  • Fax: 703-204-0356
Mailing address:
  • Phone: 704-815-7789
  • Fax: 888-401-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY GUIDRY
Title or Position: CEO
Credential:
Phone: 704-815-7804