Provider Demographics
NPI:1487348520
Name:INTERVENTIONAL CARDIOLOGY GROUP LLC
Entity type:Organization
Organization Name:INTERVENTIONAL CARDIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-260-2334
Mailing Address - Street 1:909 AVE TITO CASTRO STE 712 TORRE MEDICA SAN LUCA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4722
Mailing Address - Country:US
Mailing Address - Phone:787-813-0550
Mailing Address - Fax:
Practice Address - Street 1:101 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1647
Practice Address - Country:US
Practice Address - Phone:787-260-2334
Practice Address - Fax:787-260-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty