=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295924504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANKLIN CARDIOVASCULAR ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2007
-----------------------------------------------------
Last Update Date | 07/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 S BROAD ST STE 201
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-589-6034
-----------------------------------------------------
Fax | 215-689-1912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 438 GANTTOWN ROAD SUITES B8-B9
-----------------------------------------------------
City | SEWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08080-1887
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-589-6034
-----------------------------------------------------
Fax | 856-589-6036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | NICHOLAS L. DEPACE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 856-585-6034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207UN0901X
-----------------------------------------------------
Taxonomy Name | Nuclear Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------