Healthcare Provider Details

I. General information

NPI: 1568599652
Provider Name (Legal Business Name): CARDIOVASCULAR HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BULIFANTS BLVD SUITE B
WILLIAMSBURG VA
23188-5712
US

IV. Provider business mailing address

117 BULIFANTS BLVD SUITE B
WILLIAMSBURG VA
23188-5712
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-9540
  • Fax: 757-259-9547
Mailing address:
  • Phone: 757-259-9540
  • Fax: 757-259-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101232846
License Number StateVA

VIII. Authorized Official

Name: DR. VASUDEV G. ANANTHRAM
Title or Position: PRESIDENT
Credential: MD
Phone: 757-259-9540