Provider Demographics
NPI:1720316102
Name:CENTRAL PA CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:CENTRAL PA CARDIOLOGY, LLC
Other - Org Name:CENTRAL PA PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-201-2309
Mailing Address - Street 1:914 SOUTH 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6527
Mailing Address - Country:US
Mailing Address - Phone:814-201-2309
Mailing Address - Fax:814-201-2389
Practice Address - Street 1:914 SOUTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6527
Practice Address - Country:US
Practice Address - Phone:814-201-2309
Practice Address - Fax:814-201-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
PA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015090710009Medicaid
PA0015090710009Medicaid