Healthcare Provider Details

I. General information

NPI: 1902114911
Provider Name (Legal Business Name): SAINT VINCENT CONSULTANTS IN CARDIOVASCULAR DISEASES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST STE 190
ERIE PA
16502-4604
US

IV. Provider business mailing address

2315 MYRTLE ST SUITE 190
ERIE PA
16502-4604
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-7767
  • Fax: 814-454-6667
Mailing address:
  • Phone: 814-453-7767
  • Fax: 814-454-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK R IZZO
Title or Position: BOARD PRESIDENT
Credential: MD
Phone: 814-453-7767