Basic Information
| Provider Information | |||||||||
| NPI: | 1558568626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIEDMONT CARDIOLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 LAKE BOONE TRL | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077507 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4301 LAKE BOONE TRL | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362726133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLLMAN | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3362726133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.