Provider Demographics
NPI:1013128933
Name:INTERVENTIONAL CARDIOVASCULAR ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:INTERVENTIONAL CARDIOVASCULAR ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-441-9800
Mailing Address - Street 1:324 CAPTAINS CIR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3785
Mailing Address - Country:US
Mailing Address - Phone:302-645-1500
Mailing Address - Fax:302-258-0864
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-645-1500
Practice Address - Fax:302-258-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ626071Medicare PIN
C53672Medicare UPIN
DE363473Medicare PIN