Provider Demographics
NPI:1508905878
Name:LAUREL CARDIOLOGY PC
Entity Type:Organization
Organization Name:LAUREL CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-534-5042
Mailing Address - Street 1:1015 FRANKLIN ST
Mailing Address - Street 2:WESSEL BUILDING LEVEL D
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4110
Mailing Address - Country:US
Mailing Address - Phone:814-534-5042
Mailing Address - Fax:814-534-5045
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:WESSEL BUILDING LEVEL D
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4110
Practice Address - Country:US
Practice Address - Phone:814-534-5042
Practice Address - Fax:814-534-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058575L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015843160004Medicaid
PA0015843160004Medicaid