MEDICARE: POCONO HEART & VASCULAR 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	MD029230E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1891793683	OTHER	PA	NPI FOR DR AS INDIVIDUAL

General Provider Information

NPI Number	:	1801964432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO HEART & VASCULAR P.C.

Provider Business Mailing Address
First Line	:	HC 2 BOX 2029
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-9709
Country	:	US
Telephone Number	:	570-402-0700
Fax Number	:	570-992-6780

Provider Business Practice Location Address
First Line	:	PLEASANT VALLEY DRIVE
Second Line	:	HC 2 BOX 2029
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-9709
Country	:	US
Telephone Number	:	570-402-0700
Fax Number	:	570-992-6780

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD ALAN NARVAEZ
Credential	:	M.D.
Telephone Number	:	570-402-0700

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	09/08/2010

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