Provider Demographics
NPI:1114970175
Name:PEDIATRIC CARDIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-545-9216
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:860-545-9400
Mailing Address - Fax:860-545-9414
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9400
Practice Address - Fax:860-545-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01472Medicare ID - Type Unspecified