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General NPI Number Information
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NPI Number | 1669743134
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CARDIOVASCULAR INSTITUTE LLC
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Dates
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Enumeration Date | 01/15/2012
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Last Update Date | 01/22/2012
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Provider Practice Location Address
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Address Line | 129 W VIRGINIA BEACH BLVD SUITE 110
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City | NORFOLK
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State | VA
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Zip | 23510-2030
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Country | US
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Telephone | 757-965-2970
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Fax | 877-437-1674
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Provider Business Mailing Address
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Address Line | 5500 COVENANT CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-2385
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Country | US
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Telephone | 757-708-4501
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOPHIE PARKER
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Credential | MD
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Telephone | 757-708-4501
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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 | 0101238123
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License Number State | VA
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