Provider Demographics
NPI:1619146859
Name:CARDIOLOGISTS OF GREENE COUNTY LLC
Entity Type:Organization
Organization Name:CARDIOLOGISTS OF GREENE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:KORAYM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-376-8336
Mailing Address - Street 1:2365 LAKEVIEW DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4600
Mailing Address - Country:US
Mailing Address - Phone:937-376-8336
Mailing Address - Fax:937-376-8352
Practice Address - Street 1:2365 LAKEVIEW DR
Practice Address - Street 2:SUITE D
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4600
Practice Address - Country:US
Practice Address - Phone:937-376-8336
Practice Address - Fax:937-376-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9374171Medicare PIN