Provider Demographics
NPI:1366495111
Name:BUXMONT CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BUXMONT CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-257-1127
Mailing Address - Street 1:3 LIFE MARK DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1598
Mailing Address - Country:US
Mailing Address - Phone:215-257-1127
Mailing Address - Fax:215-257-0129
Practice Address - Street 1:3 LIFE MARK DR
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1598
Practice Address - Country:US
Practice Address - Phone:215-257-1127
Practice Address - Fax:215-257-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009631080006Medicaid
4663OtherAETNA/USHEALTHCARE
045470OtherKEYSTONE HEALTH PLAN EAST
895969Medicare ID - Type Unspecified