Provider Demographics
NPI:1124147533
Name:CARDIOVASCULAR & CRITICAL CARE ASSOC., PC
Entity type:Organization
Organization Name:CARDIOVASCULAR & CRITICAL CARE ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-681-2790
Mailing Address - Street 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE #234
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-681-2790
Mailing Address - Fax:412-681-6514
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE #234
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-681-2790
Practice Address - Fax:412-681-6514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029608E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA182641OtherHIGHMARK BCBS PROVIDER
PA0009130900003Medicaid
PAC31131Medicare UPIN
PA0009130900003Medicaid