Provider Demographics
NPI:1578515748
Name:PENNSYLVANIA HEART AND VASCULAR GROUP, P.C.
Entity Type:Organization
Organization Name:PENNSYLVANIA HEART AND VASCULAR GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-671-4280
Mailing Address - Street 1:261 OLD YORK RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3706
Mailing Address - Country:US
Mailing Address - Phone:215-885-4700
Mailing Address - Fax:215-885-6861
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:SUITE 214
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-885-4700
Practice Address - Fax:215-885-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017838200003Medicaid
PA036234OtherMEDICARE ID