MEDICARE: PHILADELPHIA PREMIER CARDIOVASCULAR CONSULTANTS LLC

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

General Provider Information

NPI Number	:	1720405178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA PREMIER CARDIOVASCULAR CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	628 MANOR RD
Second Line	:
City	:	PENN VALLEY
State	:	PA
Zip	:	19072-1617
Country	:	US
Telephone Number	:	215-383-5900
Fax Number	:	855-777-8654

Provider Business Practice Location Address
First Line	:	7452 OGONTZ AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1324
Country	:	US
Telephone Number	:	215-383-5900
Fax Number	:	855-777-8654

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANUL CORRIELUS
Credential	:	MD
Telephone Number	:	215-383-5900

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	08/14/2025

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