Provider Demographics
NPI:1689607665
Name:HENLOPEN CARDIOLOGY PA
Entity Type:Organization
Organization Name:HENLOPEN CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NASI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLOURCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-7672
Mailing Address - Street 1:18958 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9791
Mailing Address - Country:US
Mailing Address - Phone:302-645-7672
Mailing Address - Fax:
Practice Address - Street 1:123 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3829
Practice Address - Country:US
Practice Address - Phone:302-628-2687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001853207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB3761OtherRAILROAD MEDICARE
DE0001083602Medicaid
CB3761OtherRAILROAD MEDICARE