Provider Demographics
NPI:1346591278
Name:SOURCE CARDIOLOGY
Entity Type:Organization
Organization Name:SOURCE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-355-4863
Mailing Address - Street 1:953 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3428
Mailing Address - Country:US
Mailing Address - Phone:646-355-4863
Mailing Address - Fax:917-688-1502
Practice Address - Street 1:953 SOUTHERN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3428
Practice Address - Country:US
Practice Address - Phone:646-355-4863
Practice Address - Fax:917-688-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243823207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty