Provider Demographics
NPI:1326032590
Name:CARDIAC MANAGEMENT INC
Entity Type:Organization
Organization Name:CARDIAC MANAGEMENT INC
Other - Org Name:DAVID N FREDERICKA MD FACC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:FREDERICKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-373-6903
Mailing Address - Street 1:1753 E MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6672
Mailing Address - Country:US
Mailing Address - Phone:330-373-6903
Mailing Address - Fax:330-399-1055
Practice Address - Street 1:1753 E MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6672
Practice Address - Country:US
Practice Address - Phone:330-373-6903
Practice Address - Fax:330-399-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040244F207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA 9191332Medicare ID - Type Unspecified