Provider Demographics
NPI:1033527148
Name:CARDIOLOGY ASSOCIATES LGH INC
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES LGH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-452-7000
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-452-7000
Mailing Address - Fax:978-458-2828
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-452-7000
Practice Address - Fax:978-458-2828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOLOGY ASSOCIATES OF GREATER LOWELL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9764771Medicaid
MA9764771Medicaid