Provider Demographics
NPI:1093006108
Name:CARDIAC AND VASCULAR CONSULTANTS MD PA
Entity type:Organization
Organization Name:CARDIAC AND VASCULAR CONSULTANTS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHRIKANTH
Authorized Official - Middle Name:P
Authorized Official - Last Name:UPADYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-552-4648
Mailing Address - Street 1:1050 OLD CAMP RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-633-1966
Mailing Address - Fax:352-633-1969
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:SUITE 270
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-552-4648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty