Provider Demographics
NPI:1649272386
Name:CARDIOLOGY CONSULTANTS OF PHILADELPHIA, P.C.
Entity type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF PHILADELPHIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-479-4142
Mailing Address - Street 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4142
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:1703 S BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1536
Practice Address - Country:US
Practice Address - Phone:215-463-5333
Practice Address - Fax:215-463-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010768630036Medicaid
PA0010768630036Medicaid