Provider Demographics
NPI:1356581334
Name:CHESTER COUNTY HEART AND VASCULAR CENTER PC
Entity type:Organization
Organization Name:CHESTER COUNTY HEART AND VASCULAR CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAMSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-869-3564
Mailing Address - Street 1:1011 W BALTIMORE PIKE
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9446
Mailing Address - Country:US
Mailing Address - Phone:610-869-3564
Mailing Address - Fax:610-869-6042
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:STE 101
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-3564
Practice Address - Fax:610-869-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436022207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty