Provider Demographics
NPI:1053587147
Name:CARDIOLOGY ASSOCIATES AND DIAGNOSTIC CENTER, LLC
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES AND DIAGNOSTIC CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-386-6900
Mailing Address - Street 1:1241 BLAKESLEE BOULEVARD DR E
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2401
Mailing Address - Country:US
Mailing Address - Phone:570-386-6900
Mailing Address - Fax:570-386-6901
Practice Address - Street 1:1241 BLAKESLEE BOULEVARD DR E
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2401
Practice Address - Country:US
Practice Address - Phone:570-386-6900
Practice Address - Fax:570-386-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA128524Medicare PIN