Provider Demographics
NPI:1477594232
Name:DUBOIS REGIONAL CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:DUBOIS REGIONAL CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYASEELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-375-3095
Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-375-3095
Mailing Address - Fax:814-375-3363
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3095
Practice Address - Fax:814-375-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA073613Medicare ID - Type Unspecified