Provider Demographics
NPI:1295924504
Name:FRANKLIN CARDIOVASCULAR ASSOCIATES, PA
Entity type:Organization
Organization Name:FRANKLIN CARDIOVASCULAR ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEPACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-585-6034
Mailing Address - Street 1:438 GANTTOWN ROAD
Mailing Address - Street 2:SUITES B8-B9
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1887
Mailing Address - Country:US
Mailing Address - Phone:856-589-6034
Mailing Address - Fax:856-589-6036
Practice Address - Street 1:2300 S BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:856-589-6034
Practice Address - Fax:215-689-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007203462-0004Medicaid
PA178599Medicare PIN
PA007203462-0004Medicaid
PA119617Medicare PIN