Healthcare Provider Details

I. General information

NPI: 1417190240
Provider Name (Legal Business Name): THE CARDIOVASCULAR GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44035 RIVERSIDE PKWY #400
LEESBURG VA
20176-8260
US

IV. Provider business mailing address

2901 TELESTAR CT. #300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5421
  • Fax: 703-858-9573
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE Y WILLIAMSON
Title or Position: DIRECTOR OF THE BUSINESS OFFICE
Credential:
Phone: 703-591-1688