Provider Demographics
NPI:1942473103
Name:BLACKSTONE CARDIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:BLACKSTONE CARDIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:HORDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-723-1210
Mailing Address - Street 1:333 SCHOOL STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5336
Mailing Address - Country:US
Mailing Address - Phone:401-723-1210
Mailing Address - Fax:401-312-2099
Practice Address - Street 1:60 MESSENGER STREET
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762
Practice Address - Country:US
Practice Address - Phone:401-723-1210
Practice Address - Fax:401-312-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21720Medicare PIN