Healthcare Provider Details

I. General information

NPI: 1447635479
Provider Name (Legal Business Name): EOS CARDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARPENTER DR SUITE 206
STERLING VA
20164-7114
US

IV. Provider business mailing address

42881 BOLD FORBES CT
ASHBURN VA
20147-4013
US

V. Phone/Fax

Practice location:
  • Phone: 571-210-5704
  • Fax: 571-612-3758
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101252537
License Number StateVA

VIII. Authorized Official

Name: DR. OGEI YAR
Title or Position: OWNER
Credential:
Phone: 571-210-5704