MEDICARE: HARBOR CARDIOLOGY & VASCULAR CENTER PA

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
2	207RC0000X	Cardiovascular Disease Physician	ME0048592	FL

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

General Provider Information

NPI Number	:	1922189018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR CARDIOLOGY & VASCULAR CENTER PA

Provider Business Mailing Address
First Line	:	2400 HARBOR BLVD STE 12
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5038
Country	:	US
Telephone Number	:	941-625-6187
Fax Number	:	941-625-7887

Provider Business Practice Location Address
First Line	:	1620 TAMIAMI TRAIL
Second Line	:	SUITE 300
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4017
Country	:	US
Telephone Number	:	941-625-6187
Fax Number	:	941-625-7887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BALA K NANDIGAM
Credential	:	MD
Telephone Number	:	941-625-6187

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/16/2023

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Directions to “HARBOR CARDIOLOGY & VASCULAR CENTER PA ” Practice Location

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