Healthcare Provider Details

I. General information

NPI: 1588167944
Provider Name (Legal Business Name): LOUDOUN CARDIOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 STONE SPRINGS BLVD STE 500
DULLES VA
20166-2247
US

IV. Provider business mailing address

24430 STONE SPRINGS BLVD STE 500
DULLES VA
20166-2247
US

V. Phone/Fax

Practice location:
  • Phone: 703-933-0700
  • Fax:
Mailing address:
  • Phone: 703-933-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101052178
License Number StateVA

VIII. Authorized Official

Name: MRS. HASTANA RASOULY
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-933-0700