Healthcare Provider Details

I. General information

NPI: 1619945268
Provider Name (Legal Business Name): JOHN C CARDONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 211
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

1101 SAM PERRY BLVD SUITE 211
FREDERICKSBURG VA
22401-4467
US

V. Phone/Fax

Practice location:
  • Phone: 540-372-7792
  • Fax: 540-372-2073
Mailing address:
  • Phone: 540-372-7792
  • Fax: 540-372-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD048028L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101255258
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: