Healthcare Provider Details

I. General information

NPI: 1992822563
Provider Name (Legal Business Name): MIDDLETOWN CARDIOVASCULAR ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/09/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

IV. Provider business mailing address

235 N BREIEL BLVD
MIDDLETOWN OH
45042-3807
US

V. Phone/Fax

Practice location:
  • Phone: 513-783-4222
  • Fax: 513-783-4477
Mailing address:
  • Phone: 513-783-4222
  • Fax: 513-217-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SANDEEP GUPTA
Title or Position: OWNER
Credential:
Phone: 513-783-4222