Provider Demographics
NPI:1770588980
Name:GREAT VALLEY CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:GREAT VALLEY CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRESSEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-342-1776
Mailing Address - Street 1:746 JEFFERSON AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1639
Mailing Address - Country:US
Mailing Address - Phone:570-342-1776
Mailing Address - Fax:570-207-1910
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:STE 305
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1639
Practice Address - Country:US
Practice Address - Phone:570-342-1776
Practice Address - Fax:570-207-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANOT APPLICABLE207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011454230012Medicaid
PA0011454230012Medicaid