Provider Demographics
NPI:1922189018
Name:HARBOR CARDIOLOGY & VASCULAR CENTER PA
Entity Type:Organization
Organization Name:HARBOR CARDIOLOGY & VASCULAR CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NANDIGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-6187
Mailing Address - Street 1:2400 HARBOR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5038
Mailing Address - Country:US
Mailing Address - Phone:941-625-6187
Mailing Address - Fax:941-625-7887
Practice Address - Street 1:1620 TAMIAMI TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4017
Practice Address - Country:US
Practice Address - Phone:941-625-6187
Practice Address - Fax:941-625-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
FLME0048592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3084Medicare PIN