Provider Demographics
NPI:1073622544
Name:CHMC CARDIOVASCULAR SURGICAL FOUNDATION INC
Entity Type:Organization
Organization Name:CHMC CARDIOVASCULAR SURGICAL FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL NIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-355-7899
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:BADER 273
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7899
Mailing Address - Fax:617-730-0214
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BADER 273
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7899
Practice Address - Fax:617-730-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9726225Medicaid
B97206Medicare UPIN
MAM13652Medicare ID - Type Unspecified