Organization
WOODBRIDGE CARDIOVASCULAR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRACHAK SIRIPRAKORN (PRESIDENT)
(703) 491-6780
Entity
Organization
Contact information
Practice address
14904 JEFFERSON DAVIS HWY, SUITE101, WOODBRIDGE, VA 22191-3908
(703) 491-6781
(703) 491-6782
Mailing address
14904 JEFFERSON DAVIS HWY, SUITE101, WOODBRIDGE, VA 22191-3908
(703) 491-6781
(703) 491-6782
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
99409418
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108509
INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF NUCLEAR MEDICINE LABORATORIES
VA
Enumeration date
01/12/2012
Last updated
01/13/2012
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