Provider Demographics
NPI:1750345948
Name:CARDIOLOGY DIAGNOSTIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:CARDIOLOGY DIAGNOSTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-441-0536
Mailing Address - Street 1:659 SPRING GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-3033
Mailing Address - Country:US
Mailing Address - Phone:717-702-5500
Mailing Address - Fax:717-702-2500
Practice Address - Street 1:659 SPRING GARDEN DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3033
Practice Address - Country:US
Practice Address - Phone:717-731-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID NUMBER
PA=========OtherTAX ID NUMBER
PADE0676Medicare PIN