Healthcare Provider Details

I. General information

NPI: 1366498933
Provider Name (Legal Business Name): THE CARDIOVASCULAR GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GALLOWS RD STE 110
VIENNA VA
22182-4098
US

IV. Provider business mailing address

2901 TELESTAR CT. #300
FALLS CHURCH VA
22042-1261
US

V. Phone/Fax

Practice location:
  • Phone: 703-281-1265
  • Fax: 703-255-0571
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
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE Y WILLIAMSON
Title or Position: DIRECTOR OF BUSINESS OFFICE
Credential:
Phone: 703-591-1688