MEDICARE: CARDIOTHORACIC & VASCULAR ASSOC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MA027421	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020010075	OTHER	NJ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1053365460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOTHORACIC & VASCULAR ASSOC PC

Provider Business Mailing Address
First Line	:	1760 WHITEHORSE HAMILTON SQUARE RD
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08690-3535
Country	:	US
Telephone Number	:	609-890-2966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 WHITEHORSE HAMILTON SQUARE RD
Second Line	:
City	:	TRENTON
State	:	NJ
Zip	:	08690-3535
Country	:	US
Telephone Number	:	609-890-2966
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	IMTIAZ AHMAD
Credential	:	M.D.
Telephone Number	:	60198900393

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	10/18/2010

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