Provider Demographics
NPI:1295960458
Name:MAIN LINE CARDIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:MAIN LINE CARDIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-2400
Mailing Address - Street 1:PAOLI MEMORIAL HOSPITAL BLDG 2
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-647-2400
Mailing Address - Fax:610-647-3902
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010769160008Medicaid
PA0010769160008Medicaid