Provider Demographics
NPI:1861494056
Name:EASTON CARDIOVASCULAR ASSOCIATES, PC
Entity Type:Organization
Organization Name:EASTON CARDIOVASCULAR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-973-1410
Mailing Address - Street 1:2001 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3915
Mailing Address - Country:US
Mailing Address - Phone:610-258-4337
Mailing Address - Fax:610-258-8502
Practice Address - Street 1:175 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3835
Practice Address - Country:US
Practice Address - Phone:610-442-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3501205Medicaid
PA2402700OtherCAPITAL BLUE CROSS
NJ1404850OtherHIGHMARK--NEW JERSEY
PA1504209Medicaid
PA17258OtherAETNA US HEALTHCARE
PA733485Medicaid
PA119129OtherHIGHMARK PA
PA119129OtherKEYSTONE CAPITAL
PACF6140OtherPALMETTO RR PA
PA119129Medicare PIN
NJ026986Medicare PIN