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General NPI Number Information
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NPI Number | 1457072100
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Entity Type | Organization
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Legal Business Name | CARDINAL HEALTHCARE
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 436 HOSPITAL DR
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City | WARRENTON
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State | VA
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Zip | 20186-3026
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Country | US
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Telephone | 540-216-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 436 HOSPITAL DR
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City | WARRENTON
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State | VA
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Zip | 20186-3026
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Country | US
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Telephone | 540-216-7776
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MITRA HAFEZI
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Credential | MD
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Telephone | 540-216-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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