Healthcare Provider Details

I. General information

NPI: 1558615526
Provider Name (Legal Business Name): ADVANTAGE CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W MARKET ST SUITE 330
LIMA OH
45805-2773
US

IV. Provider business mailing address

PO BOX 11544
BELFAST ME
04915-4006
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-1100
  • Fax: 419-222-1104
Mailing address:
  • Phone: 419-222-1100
  • Fax: 419-222-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35091558
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. EBERE MAXWELL UGWANYI
Title or Position: CARDIOLOGIST/OWNER
Credential: M.D.
Phone: 419-222-1100