Healthcare Provider Details

I. General information

NPI: 1619236304
Provider Name (Legal Business Name): DOMINION CARDIOVASCULAR ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 DARBY BROOK CT
LAKE RIDGE VA
22192-2486
US

IV. Provider business mailing address

PO BOX 5433
MC LEAN VA
22103-5433
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-4190
  • Fax: 866-239-6997
Mailing address:
  • Phone: 703-346-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101058310
License Number StateVA

VIII. Authorized Official

Name: DR. JUN ANTHONY VENTURA QUION
Title or Position: PRESIDENT
Credential: M.D. FACC
Phone: 703-346-6388