Provider Demographics
NPI:1952720831
Name:BEACON CARDIOLOGY, P.A.
Entity Type:Organization
Organization Name:BEACON CARDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVIKATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-322-2055
Mailing Address - Street 1:5757 WARREN PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4274
Mailing Address - Country:US
Mailing Address - Phone:214-556-5351
Mailing Address - Fax:
Practice Address - Street 1:5757 WARREN PKWY STE 208
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:214-556-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1020207RC0000X
TXL1266207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty