MEDICARE: CARDIOLOGY CONSULTANTS OF PHILADELPHIA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649272386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY CONSULTANTS OF PHILADELPHIA, P.C.

Provider Business Mailing Address
First Line	:	207 N BROAD ST FL 3
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19107-1500
Country	:	US
Telephone Number	:	267-479-4142
Fax Number	:	215-463-3820

Provider Business Practice Location Address
First Line	:	1703 S BROAD ST STE 300
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1536
Country	:	US
Telephone Number	:	215-463-5333
Fax Number	:	215-463-8085

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	LYDIA L MUTCH
Credential	:
Telephone Number	:	267-479-4142

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	09/02/2020

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