MEDICARE: CARDIOVASCULAR MEDICAL ASSOCIATES, P C

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	MD019676E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00046000	OTHER	PA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0716167000	OTHER	PA	IBC

General Provider Information

NPI Number	:	1144339011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR MEDICAL ASSOCIATES, P C

Provider Business Mailing Address
First Line	:	PO BOX 58263
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-8263
Country	:	US
Telephone Number	:	215-629-1159
Fax Number	:	215-923-7621

Provider Business Practice Location Address
First Line	:	818 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5104
Country	:	US
Telephone Number	:	215-629-1159
Fax Number	:	215-923-7621

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP NIMOITYN
Credential	:	MD
Telephone Number	:	215-629-1159

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/26/2010

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