Provider Demographics
NPI:1073567418
Name:DELAWARE CARDIOVASCULAR ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DELAWARE CARDIOVASCULAR ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHRAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKANATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-661-1661
Mailing Address - Street 1:1403 FOULK RD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2788
Mailing Address - Country:US
Mailing Address - Phone:302-661-1661
Mailing Address - Fax:302-661-1001
Practice Address - Street 1:1403 FOULK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2788
Practice Address - Country:US
Practice Address - Phone:302-661-7676
Practice Address - Fax:302-661-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE635578OtherMEDICARE PTAN NUMBER