Healthcare Provider Details

I. General information

NPI: 1194702340
Provider Name (Legal Business Name): CARDIOLOGY INTERPRETIVE SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 NORMAN DRIVE
LEBANON PA
17042
US

IV. Provider business mailing address

775 NORMAN DR
LEBANON PA
17042-7497
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-5500
  • Fax: 717-202-0130
Mailing address:
  • Phone: 717-274-5500
  • Fax: 717-202-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M CLEMENS
Title or Position: PRESIDENT
Credential: MD
Phone: 717-274-5500