Healthcare Provider Details

I. General information

NPI: 1467491217
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF GREATER HAZLETON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N VINE ST
HAZLETON PA
18201
US

IV. Provider business mailing address

141 N VINE ST
HAZLETON PA
18201
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-2467
  • Fax: 570-455-2070
Mailing address:
  • Phone: 570-454-2467
  • Fax: 570-455-2070

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:

# 1
IdentifierDB2081
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier02853600
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS
# 3
Identifier0007606510002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: THOMAS J CIOTOLA
Title or Position: PRESIDENT
Credential: MD
Phone: 570-454-2467