Provider Demographics
NPI:1639114903
Name:DYNAMIC HEART CARE, LLC
Entity type:Organization
Organization Name:DYNAMIC HEART CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-660-0800
Mailing Address - Street 1:25 BALA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3213
Mailing Address - Country:US
Mailing Address - Phone:610-660-0800
Mailing Address - Fax:610-660-0360
Practice Address - Street 1:25 BALA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3213
Practice Address - Country:US
Practice Address - Phone:610-660-0800
Practice Address - Fax:610-660-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA046788Medicare ID - Type UnspecifiedMEDICARE GROUP #