Provider Demographics
NPI:1750439295
Name:CARDIOVASCULAR ASSOCIATES P.C.
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-300-2240
Mailing Address - Street 1:1901 SPRINGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2303
Mailing Address - Country:US
Mailing Address - Phone:251-300-2240
Mailing Address - Fax:251-300-2249
Practice Address - Street 1:1901 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2303
Practice Address - Country:US
Practice Address - Phone:251-300-2240
Practice Address - Fax:251-300-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528902820Medicaid
MS9013763Medicaid
ALCI0760Medicare PIN
AL528902820Medicaid