Healthcare Provider Details

I. General information

NPI: 1942512504
Provider Name (Legal Business Name): EAST CARDIOVASCULAR SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 E VIRGINIA BEACH BLVD STE 200
NORFOLK VA
23502-2851
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD STE 200
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-222-0012
  • Fax: 888-607-9653
Mailing address:
  • Phone: 757-222-0012
  • Fax: 888-607-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK ANTHONY EAST
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 757-222-0012