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General NPI Number Information
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NPI Number | 1215021506
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Entity Type | Organization
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Legal Business Name | POTOMAC CARDIOVASCULAR CONSULTANTS, LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2010 OPITZ BLVD STE C
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3359
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Country | US
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Telephone | 703-730-8002
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Fax | 703-730-8025
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Provider Business Mailing Address
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Address Line | 2280 OPITZ BLVD STE 260
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-730-8002
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Fax | 703-730-8025
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARIANO D. CHUTUAPE
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Credential | M.D.
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Telephone | 703-730-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 101053905
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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