Provider Demographics
NPI:1568516243
Name:GREATER PHILADELPHIA CARDIOLOGY ASSC INC
Entity Type:Organization
Organization Name:GREATER PHILADELPHIA CARDIOLOGY ASSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-880-7090
Mailing Address - Street 1:3998 RED LION RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-880-7090
Mailing Address - Fax:215-281-2725
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-880-7090
Practice Address - Fax:215-281-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA691432Medicare UPIN