Provider Demographics
NPI:1598773962
Name:CARDIOVASCULAR SURGICAL ASSOCIATES OF LEBANON, INC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SURGICAL ASSOCIATES OF LEBANON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAFZIGER-EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-3759
Mailing Address - Street 1:FOURTH AND WALNUT STREETS
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-270-3751
Mailing Address - Fax:717-270-3754
Practice Address - Street 1:FOURTH AND WALNUT STREETS
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-270-3751
Practice Address - Fax:717-270-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043753E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088860Medicare ID - Type Unspecified