Provider Demographics
NPI:1386923639
Name:DOMINION CARDIOLOGY PC
Entity type:Organization
Organization Name:DOMINION CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARUQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-520-1080
Mailing Address - Street 1:2563 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2407
Mailing Address - Country:US
Mailing Address - Phone:804-520-1080
Mailing Address - Fax:804-520-1906
Practice Address - Street 1:2563 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2407
Practice Address - Country:US
Practice Address - Phone:804-520-1080
Practice Address - Fax:804-520-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246823207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205886900Medicaid
VAA282Medicare PIN