Healthcare Provider Details

I. General information

NPI: 1467055152
Provider Name (Legal Business Name): CHILDRENS CARDIAC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 EMANCIPATION HWY STE 201
FREDERICKSBURG VA
22401-4566
US

IV. Provider business mailing address

609 EMANCIPATION HWY STE 201
FREDERICKSBURG VA
22401-4566
US

V. Phone/Fax

Practice location:
  • Phone: 540-322-4949
  • Fax: 571-376-6553
Mailing address:
  • Phone: 540-322-4949
  • Fax: 571-376-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIR DANGOL
Title or Position: MEMBER MANAGER
Credential:
Phone: 571-364-2301