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General NPI Number Information
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NPI Number | 1649272386
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CONSULTANTS OF PHILADELPHIA, P.C.
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1703 S BROAD ST STE 300
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1536
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Country | US
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Telephone | 215-463-5333
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Fax | 215-463-8085
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Provider Business Mailing Address
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Address Line | 207 N BROAD ST FL 3
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City | PHILA
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State | PA
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Zip | 19107-1500
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Country | US
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Telephone | 267-479-4142
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Fax | 215-463-3820
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | LYDIA L MUTCH
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Credential |
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Telephone | 267-479-4142
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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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