Basic Information
| Provider Information | |||||||||
| NPI: | 1275584401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIAC DIAGNOSTIC ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | 7178124867 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MONUMENT RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | 7178124867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 05/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILKINSON | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7178511405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 5438 | 01 | PA | GEISINGER | OTHER | 87055 | 01 | PA | UNISON | OTHER | 000696434 | 05 | PA | MEDICAID | 59003 | 01 | PA | AETNA | OTHER | K776 | 01 | PA | CAREFIRST BLUE CROSS BLUE SHIELD | OTHER | 110376 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1041805 | 01 | PA | GATEWAY | OTHER | 20009633 | 01 | PA | AMERIHEALTH MERCY | OTHER | 2364800 | 01 | PA | CAPITAL BLUE CROSS | OTHER | CF7671 | 01 | PA | RAILROAD MEDICARE | OTHER |