Healthcare Provider Details

I. General information

NPI: 1053373746
Provider Name (Legal Business Name): FLAGSHIP CARDIAC VASCULAR AND THORACIC SURGERY OF ERIE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-6751
  • Fax:
Mailing address:
  • Phone: 814-453-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY SUE FELLOWS
Title or Position: OFFICE MANAGER
Credential:
Phone: 814-453-6751