Healthcare Provider Details

I. General information

NPI: 1427362870
Provider Name (Legal Business Name): CARDIOVASCULAR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S BRINTON LAKE RD
GLEN MILLS PA
19342-2281
US

IV. Provider business mailing address

1 BARTOL AVE STE 10
RIDLEY PARK PA
19078-2214
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-0150
  • Fax: 610-521-6493
Mailing address:
  • Phone: 610-521-0150
  • Fax: 610-521-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. SAMUEL R RUBY
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 610-521-0150