Healthcare Provider Details

I. General information

NPI: 1013128933
Provider Name (Legal Business Name): INTERVENTIONAL CARDIOVASCULAR ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16529 COASTAL HWY SUITE 125
LEWES DE
19958-3605
US

IV. Provider business mailing address

324 CAPTAINS CIR
LEWES DE
19958-3785
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-1500
  • Fax: 302-258-0864
Mailing address:
  • Phone: 302-645-1500
  • Fax: 302-258-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ROGER HOWARD COLETTI
Title or Position: PRESIDENT
Credential: MD
Phone: 201-441-9800