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General NPI Number Information
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NPI Number | 1831142470
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Entity Type | Organization
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Legal Business Name | HEART GROUP PA
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 310
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2781
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Country | US
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Telephone | 386-257-6644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9254
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City | DAYTONA BEACH
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State | FL
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Zip | 32120-9254
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Country | US
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Telephone | 386-290-7886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK B. BARETTELLA
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Credential | M.D.
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Telephone | 386-257-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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