Healthcare Provider Details

I. General information

NPI: 1114971918
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ SUITE 100
CHESAPEAKE VA
23320-5041
US

IV. Provider business mailing address

5700 CLEVELAND STREET SUITE 228
VIRGINIA BEACH VA
23462-1752
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9294
  • Fax: 757-213-9341
Mailing address:
  • Phone: 757-499-2825
  • Fax: 757-499-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT DONLON
Title or Position: ADMINSTRATOR
Credential:
Phone: 757-499-2825