Organization
CARDIAC CARE CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHOSRO SHAREGHI (OWNER)
(703) 494-5995
Entity
Organization
Contact information
Practice address
2200 OPITZ BLVD, S 310, WOODBRIDGE, VA 22191
(703) 494-5995
(703) 491-9153
Mailing address
2200 OPITZ BLVD, S 310, WOODBRIDGE, VA 22191
(703) 494-5995
(703) 491-9153
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000028690
B C
—
05
—
006029833
—
VA
01
—
4252028
AETNA
—
Enumeration date
11/07/2006
Last updated
05/22/2013
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