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General NPI Number Information
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NPI Number | 1174700306
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Entity Type | Organization
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Legal Business Name | AG CARDIOLOGY, INC
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 5062 STATE ROUTE 125
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City | GEORGETOWN
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State | OH
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Zip | 45121-9561
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Country | US
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Telephone | 937-378-9090
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Fax | 937-378-0102
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | GEORGETOWN
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State | OH
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Zip | 45121-0577
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Country | US
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Telephone | 937-378-9090
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Fax | 937-378-0102
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MR. ALI R GHASEMZADEH
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Credential | M.D.
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Telephone | 937-378-9090
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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 | 38551
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35080480G
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License Number State | OH
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