Provider Demographics
NPI:1033165592
Name:MAIN LINE CARDIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:MAIN LINE CARDIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MAIN LINE CARDIOLOGY ASSO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-2400
Mailing Address - Street 1:PAOLI MEMORIAL MEDICAL
Mailing Address - Street 2:BLDG 2 STE 328
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301
Mailing Address - Country:US
Mailing Address - Phone:610-647-2400
Mailing Address - Fax:610-647-3902
Practice Address - Street 1:PAOLI MEMORIAL MEDICAL
Practice Address - Street 2:BLDG 2 STE 328
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001076916009Medicaid
PA0093111OtherUS HEALTHCARE
PA0108847000OtherAMERIHEALTH KEYSTONE NJ
PA018847000OtherKEYSTONE
PA1010783OtherAETNA PPO
PA500661OtherPA BLUE SHIELD
PA500661OtherCOMMERCIAL INS
PACF4261OtherTRAVELERS MEDICARE
PA01010769160007OtherAMERIHEALTH AHPA
PA000274401OtherAMERICHOICE
PA0108847000OtherBS PERSONAL CHOICE
PA500661OtherPA BLUE SHIELD
PACF4261OtherTRAVELERS MEDICARE
PA500661OtherPA BLUE SHIELD