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General NPI Number Information
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NPI Number | 1679508063
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR ASSOCIATES OF LAKE COUNTY, PA
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 1879 NIGHTINGALE LANE SUITE C-1
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 352-742-1171
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Fax | 352-742-7241
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Provider Business Mailing Address
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Address Line | 1879 NIGHTINGALE LANE SUITE C-1
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 352-742-1171
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Fax | 352-742-7241
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL J GOSS
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Credential | D.O.
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Telephone | 352-742-1171
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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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