Provider Demographics
NPI:1205874666
Name:CITY LINE CARDIOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:CITY LINE CARDIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACENTRA-SESSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-660-9895
Mailing Address - Street 1:301 E CITY LINE AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-660-9895
Mailing Address - Fax:610-660-9755
Practice Address - Street 1:301 E CITY LINE AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-660-9895
Practice Address - Fax:610-660-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005160L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0109213203OtherAMERICHOICE
PA698534OtherHIGHMARK BLUE SHIELD
PA0010921320006Medicaid
PA0459499000OtherINDEPENDENCE BLUE CROSS
PA28356OtherHEALTH PARTNERS
PA30291AOtherKEYSTONE MERCY
PA195809Medicare ID - Type Unspecified
PA0010921320006Medicaid