Provider Demographics
NPI:1053152652
Name:DELAWARE HEART AND VASCULAR GROUP LLC
Entity type:Organization
Organization Name:DELAWARE HEART AND VASCULAR GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:INNASIMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-867-8396
Mailing Address - Street 1:94A OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2066
Mailing Address - Country:US
Mailing Address - Phone:412-867-8396
Mailing Address - Fax:
Practice Address - Street 1:94A OMEGA DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2066
Practice Address - Country:US
Practice Address - Phone:302-550-3484
Practice Address - Fax:302-556-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty