Basic Information
| Provider Information | |||||||||
| NPI: | 1922070275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANOVER CARDIOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 STOCK ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176371738 | ||||||||
| FaxNumber: | 7176373044 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 STOCK ST | ||||||||
| Address2: | HANOVER CARDIOLOGY ASSOCIATES PC | ||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176371738 | ||||||||
| FaxNumber: | 7176371738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7176371738 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CAPPM | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 178914 | 05 | PA | MEDICAID |