Provider Demographics
NPI:1841234564
Name:CARDIOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-366-7665
Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5438
Mailing Address - Country:US
Mailing Address - Phone:302-366-7665
Mailing Address - Fax:302-366-0734
Practice Address - Street 1:252 CHAPMAN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5438
Practice Address - Country:US
Practice Address - Phone:302-366-7665
Practice Address - Fax:302-366-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1841234564Medicaid
DE146816Medicare ID - Type Unspecified