Healthcare Provider Details

I. General information

NPI: 1871538181
Provider Name (Legal Business Name): VIRGINIA CARDIOVASCULAR SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SAM PERRY BLVD SUITE 230
FREDERICKSBURG VA
22401-4490
US

IV. Provider business mailing address

1201 SAM PERRY BLVD SUITE 230
FREDERICKSBURG VA
22401-4490
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 Number0101238100
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101051700
License Number StateVA

VIII. Authorized Official

Name: JOHN ARMITAGE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 540-372-7792