Healthcare Provider Details

I. General information

NPI: 1801341193
Provider Name (Legal Business Name): THE HEART DOCTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 DITZ DR
MANHEIM PA
17545-9383
US

IV. Provider business mailing address

637 DITZ DR
MANHEIM PA
17545-9383
US

V. Phone/Fax

Practice location:
  • Phone: 814-603-1222
  • Fax: 717-745-3835
Mailing address:
  • Phone: 814-603-1222
  • Fax: 717-745-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD072140L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: GEORGE ANGHELOIU
Title or Position: OWNER
Credential: MD
Phone: 814-603-1222