Provider Demographics
NPI:1801964432
Name:POCONO HEART & VASCULAR P.C.
Entity type:Organization
Organization Name:POCONO HEART & VASCULAR P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NARVAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-402-0700
Mailing Address - Street 1:HC 2 BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-9709
Mailing Address - Country:US
Mailing Address - Phone:570-402-0700
Mailing Address - Fax:570-992-6780
Practice Address - Street 1:PLEASANT VALLEY DRIVE
Practice Address - Street 2:HC 2 BOX 2029
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-9709
Practice Address - Country:US
Practice Address - Phone:570-402-0700
Practice Address - Fax:570-992-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029230E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011181030013Medicaid
PA1891793683OtherNPI FOR DR AS INDIVIDUAL
PA0011181030013Medicaid
PAC31085Medicare UPIN