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General NPI Number Information
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NPI Number | 1932479516
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Entity Type | Organization
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Legal Business Name | WOODBRIDGE CARDIOVASCULAR CENTER
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 14904 JEFFERSON DAVIS HWY SUITE101
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-491-6781
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Fax | 703-491-6782
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Provider Business Mailing Address
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Address Line | 14904 JEFFERSON DAVIS HWY SUITE101
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-491-6781
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Fax | 703-491-6782
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRACHAK SIRIPRAKORN
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Credential |
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Telephone | 703-491-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 99409418
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License Number State | VA
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