Healthcare Provider Details

I. General information

NPI: 1205598224
Provider Name (Legal Business Name): PONDVILLE CARDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 PINE ST STE 102
NORFOLK MA
02056-1680
US

IV. Provider business mailing address

31 PINE ST STE 102
NORFOLK MA
02056-1680
US

V. Phone/Fax

Practice location:
  • Phone: 508-623-3700
  • Fax:
Mailing address:
  • Phone: 508-623-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMAD R. EL-ZARU
Title or Position: PRESIDENT
Credential: MD
Phone: 508-623-3700