Provider Demographics
NPI:1437112661
Name:CAPITAL HEART ASSOC, P A
Entity Type:Organization
Organization Name:CAPITAL HEART ASSOC, P A
Other - Org Name:CAPITAL HEART ASSOCIATES, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-881-0160
Mailing Address - Street 1:PO BOX 33155
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27636-3155
Mailing Address - Country:US
Mailing Address - Phone:919-881-0160
Mailing Address - Fax:919-881-0887
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-881-0160
Practice Address - Fax:919-881-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437112661OtherNPI
NC0190EOtherBLUE CROSS/BLUE SHIELD
NC890190EMedicaid
CL6139OtherRAILROAD MEDICARE
5727215OtherAETNA
NC890190EMedicaid