Basic Information
| Provider Information | |||||||||
| NPI: | 1386738326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEHIGH VALLEY CARDIO DIAGNOSTICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3667 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181060667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102892980 | ||||||||
| FaxNumber: | 6102892990 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 S CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 201A | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102892980 | ||||||||
| FaxNumber: | 6102892990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PANTANO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6107702200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0010094680011 | 05 | PA | MEDICAID |