Provider Demographics
NPI:1831264829
Name:PENNSYLVANIA HEART GROUP LTD
Entity type:Organization
Organization Name:PENNSYLVANIA HEART GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-322-1364
Mailing Address - Street 1:490 EAST NORTH AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-322-1364
Mailing Address - Fax:412-322-2149
Practice Address - Street 1:490 EAST NORTH AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-322-1364
Practice Address - Fax:412-322-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
171948Medicare ID - Type Unspecified