Provider Demographics
NPI:1922041771
Name:CARDIOLOGY READING PANEL LLC
Entity Type:Organization
Organization Name:CARDIOLOGY READING PANEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-887-4093
Mailing Address - Street 1:3 GATES CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1120
Mailing Address - Country:US
Mailing Address - Phone:716-887-4093
Mailing Address - Fax:716-887-5540
Practice Address - Street 1:3 GATES CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1120
Practice Address - Country:US
Practice Address - Phone:716-887-4093
Practice Address - Fax:716-887-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02077310Medicaid
NYAA0543Medicare ID - Type Unspecified