Provider Demographics
NPI:1508833880
Name:WYOMING VALLEY HEART GROUP INC.
Entity Type:Organization
Organization Name:WYOMING VALLEY HEART GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:570-654-2533
Mailing Address - Street 1:1099 S TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3247
Mailing Address - Country:US
Mailing Address - Phone:570-654-2533
Mailing Address - Fax:570-654-2539
Practice Address - Street 1:1099 S TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3247
Practice Address - Country:US
Practice Address - Phone:570-654-2533
Practice Address - Fax:570-654-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA711404Medicare ID - Type Unspecified