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General NPI Number Information
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NPI Number | 1649381724
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Entity Type | Organization
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Legal Business Name | CARDIAC CARE ASSOCIATES PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 3023 HAMAKER CT SUITE #100
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-641-9161
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Fax | 703-641-0383
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Provider Business Mailing Address
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Address Line | 3023 HAMAKER COURT SUITE #100
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 703-641-9161
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Fax | 703-641-0383
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Authorized Official
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Title or Position | MD MANAGING PARTNER
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Name | DR. KENNETH M BROOKS
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Credential | MD
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Telephone | 703-641-9161
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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 |
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License Number State |
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