=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063419927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN VIRGINIA CARDIOLOGY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2005
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8505 ARLINGTON BLVD SUITE 200
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-573-2360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8505 ARLINGTON BLVD SUITE 200
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-573-2360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | WILLIAM DOKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-573-2360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0011524230
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------