Healthcare Provider Details

I. General information

NPI: 1578515748
Provider Name (Legal Business Name): PENNSYLVANIA HEART AND VASCULAR GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 OLD YORK RD SUITE 214
JENKINTOWN PA
19046-3706
US

IV. Provider business mailing address

261 OLD YORK RD SUITE 214
JENKINTOWN PA
19046-3706
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-4700
  • Fax: 215-885-6861
Mailing address:
  • Phone: 215-885-4700
  • Fax: 215-885-6861

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: MICHAEL FRAIETTA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 215-671-4280