Basic Information
| Provider Information | |||||||||
| NPI: | 1730253964 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAZARETH CARDIOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7780-3037 | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153354944 | ||||||||
| FaxNumber: | 2153313619 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 HOLME AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153354944 | ||||||||
| FaxNumber: | 2153313619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | VASSALLO | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 2153354944 | ||||||||
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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 SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.