Healthcare Provider Details

I. General information

NPI: 1508542168
Provider Name (Legal Business Name): THE CARDIOVASCULAR GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SUNRISE VALLEY DR STE 500
RESTON VA
20191-5303
US

IV. Provider business mailing address

2901 TELESTAR CT STE 300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-5977
  • Fax: 703-478-2475
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE Y. WILLIAMSON
Title or Position: BILLING MANAGER
Credential:
Phone: 703-621-2268