Provider Demographics
NPI:1275584401
Name:CARDIAC DIAGNOSTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CARDIAC DIAGNOSTIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-851-1405
Mailing Address - Street 1:25 MONUMENT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5060
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:717-812-4867
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-812-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5438OtherGEISINGER
PA87055OtherUNISON
PA000696434Medicaid
PA59003OtherAETNA
PAK776OtherCAREFIRST BLUE CROSS BLUE SHIELD
PA110376OtherHIGHMARK BLUE SHIELD
PA1041805OtherGATEWAY
PA20009633OtherAMERIHEALTH MERCY
PA2364800OtherCAPITAL BLUE CROSS
PACF7671OtherRAILROAD MEDICARE
PA000696434Medicaid