Healthcare Provider Details

I. General information

NPI: 1336375757
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

IV. Provider business mailing address

618 PLEASANTVILLE RD SUITE 101
LANCASTER OH
43130-3312
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-7511
  • Fax: 740-653-7512
Mailing address:
  • Phone: 740-653-7511
  • Fax: 740-653-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35082038
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35082038
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number35082038
License Number StateOH

VIII. Authorized Official

Name: SHANTANU SINHA
Title or Position: CO-OWNER
Credential: M.D.
Phone: 740-653-7511