Healthcare Provider Details

I. General information

NPI: 1124055470
Provider Name (Legal Business Name): CARDIOVASCULAR CENTER OF HAMPTON ROADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE SUITE 110
NEWPORT NEWS VA
23606-2565
US

IV. Provider business mailing address

11803 JEFFERSON AVE SUITE 110
NEWPORT NEWS VA
23606-2565
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-0360
  • Fax: 757-873-0847
Mailing address:
  • Phone: 757-873-0360
  • Fax: 757-873-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number635042
License Number StateVA

VIII. Authorized Official

Name: DR. HUGH B MCCORMICK JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-873-0360