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General NPI Number Information
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NPI Number | 1356581334
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Entity Type | Organization
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Legal Business Name | CHESTER COUNTY HEART AND VASCULAR CENTER PC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 1011 W BALTIMORE PIKE STE 101
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City | WEST GROVE
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State | PA
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Zip | 19390-9446
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Country | US
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Telephone | 610-869-3564
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Fax | 610-869-6042
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Provider Business Mailing Address
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Address Line | 1011 W BALTIMORE PIKE STE 101
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City | WEST GROVE
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State | PA
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Zip | 19390-9446
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Country | US
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Telephone | 610-869-3564
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Fax | 610-869-6042
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | FADI M SHAMSHAM
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Credential | MD
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Telephone | 610-869-3564
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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 | MD436022
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License Number State | PA
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