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General NPI Number Information
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NPI Number | 1396176228
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Entity Type | Organization
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Legal Business Name | DOMINION CARDIOVASCULAR SPECIALISTS LLC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 7129 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4073
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Country | US
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Telephone | 610-517-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 7129 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4073
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Country | US
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Telephone | 610-517-3899
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR/PHYSICIAN
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Name | AGHA W HAIDER
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Credential | MD
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Telephone | 610-517-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101247463
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License Number State | VA
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