Healthcare Provider Details

I. General information

NPI: 1093812299
Provider Name (Legal Business Name): CARDIAC & THORACIC SURGICAL ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD SUITE 500
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7101 JAHNKE RD SUITE 500
RICHMOND VA
23225-4017
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-2751
  • Fax: 804-330-3831
Mailing address:
  • Phone: 804-320-2751
  • Fax: 804-330-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY P LANGE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 804-272-4761