Healthcare Provider Details

I. General information

NPI: 1245331669
Provider Name (Legal Business Name): CARDIOTHORACIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

1360 WYOMING AVE
SCRANTON PA
18509-2803
US

V. Phone/Fax

Practice location:
  • Phone: 570-963-1740
  • Fax: 570-963-5780
Mailing address:
  • Phone: 570-963-1740
  • Fax: 570-963-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery 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: MS. SHERRY A DEAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 570-963-1740