MEDICARE: THE HEART GROUP OF THE LAUREL HIGHLANDS 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	MD029063L	PA

General Provider Information

NPI Number	:	1790780146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEART GROUP OF THE LAUREL HIGHLANDS PC

Provider Business Mailing Address
First Line	:	1020 FRANKLIN ST
Second Line	:	STE GS-G01
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4109
Country	:	US
Telephone Number	:	814-534-1035
Fax Number	:	814-534-1211

Provider Business Practice Location Address
First Line	:	1020 FRANKLIN ST
Second Line	:	STE GS-G01
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4109
Country	:	US
Telephone Number	:	814-534-1035
Fax Number	:	814-534-1211

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS CARDELLINO, JR.
Credential	:	MD
Telephone Number	:	814-534-1035

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/14/2010

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