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General NPI Number Information
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NPI Number | 1104152768
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Entity Type | Organization
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Legal Business Name | CARDIAC AND VASCULAR ASSOCIATES LLC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 1851 MESQUITE AVE SUITE 202
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5677
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Country | US
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Telephone | 928-855-5090
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Fax | 928-855-9227
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Provider Business Mailing Address
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Address Line | 301 NORTHLAKE RD
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City | COLUMBIA
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State | SC
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Zip | 29223-6009
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Country | US
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Telephone | 803-730-6790
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Fax | 803-736-5536
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Authorized Official
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Title or Position | MEMBER
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Name | MELVYN V MAHON
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Credential | M.D.
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Telephone | 803-730-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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