1033165592 NPI number — MAIN LINE CARDIOLOGY ASSOCIATES PC

Table of content: (NPI 1033165592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033165592 NPI number — MAIN LINE CARDIOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAIN LINE CARDIOLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033165592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PAOLI MEMORIAL MEDICAL
Provider Second Line Business Mailing Address:
BLDG 2 STE 328
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-647-2400
Provider Business Mailing Address Fax Number:
610-647-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PAOLI MEMORIAL MEDICAL
Provider Second Line Business Practice Location Address:
BLDG 2 STE 328
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-647-2400
Provider Business Practice Location Address Fax Number:
610-647-3902
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GERBER
Authorized Official First Name:
ELLIOT
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
PRESIDENT MAIN LINE CARDIOLOGY ASSO
Authorized Official Telephone Number:
610-647-2400

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001076916009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0093111 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0108847000 . This is a "AMERIHEALTH KEYSTONE NJ" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 018847000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010783 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 500661 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 500661 . This is a "COMMERCIAL INS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CF4261 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01010769160007 . This is a "AMERIHEALTH AHPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000274401 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0108847000 . This is a "BS PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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