Provider Demographics
NPI:1164006870
Name:CARDIOVASCULAR EXPERTS OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR EXPERTS OF PENNSYLVANIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-727-0480
Mailing Address - Street 1:3040 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4539
Mailing Address - Country:US
Mailing Address - Phone:717-727-0480
Mailing Address - Fax:717-327-4613
Practice Address - Street 1:3040 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4539
Practice Address - Country:US
Practice Address - Phone:717-727-0480
Practice Address - Fax:717-727-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid