Healthcare Provider Details

I. General information

NPI: 1518067867
Provider Name (Legal Business Name): BLUE RIDGE CARDIOVASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SOUTHRIDGE PKWY
CULPEPER VA
22701-3791
US

IV. Provider business mailing address

440 SOUTHRIDGE PKWY
CULPEPER VA
22701-3791
US

V. Phone/Fax

Practice location:
  • Phone: 540-829-4374
  • Fax: 540-829-4178
Mailing address:
  • Phone: 540-829-4374
  • Fax: 540-829-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101240088
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number010139420
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number0101039420
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101039420
License Number StateVA

VIII. Authorized Official

Name: DEBORAH N CARTER
Title or Position: BILLING MANAGER
Credential:
Phone: 540-829-4374