Provider Demographics
NPI:1639216088
Name:POCONO CARDIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:POCONO CARDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-424-9952
Mailing Address - Street 1:200 PLAZA CT STE C
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8259
Mailing Address - Country:US
Mailing Address - Phone:570-424-9952
Mailing Address - Fax:
Practice Address - Street 1:200 PLAZA CT STE C
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8259
Practice Address - Country:US
Practice Address - Phone:570-424-9952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA745366OtherMEDICARE GROUP NUMBER