Provider Demographics
NPI:1356468490
Name:MAGUS PEDIATRIC CARDIOLOGY, PA
Entity Type:Organization
Organization Name:MAGUS PEDIATRIC CARDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-238-5437
Mailing Address - Street 1:PO BOX 740127
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-0127
Mailing Address - Country:US
Mailing Address - Phone:972-238-5437
Mailing Address - Fax:972-238-5434
Practice Address - Street 1:648 W CAMPBELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3300
Practice Address - Country:US
Practice Address - Phone:972-238-5437
Practice Address - Fax:972-238-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA45576208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095042001Medicaid
TX095042001Medicaid
TX8324N0Medicare ID - Type Unspecified