Provider Demographics
NPI:1194116848
Name:ORLANDO CARDIAC AND VASCULAR SPECIALISTS LLC
Entity type:Organization
Organization Name:ORLANDO CARDIAC AND VASCULAR SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMBIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-915-5643
Mailing Address - Street 1:PO BOX 940145
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 MAITLAND AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-915-5643
Practice Address - Fax:407-960-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95035207RC0000X, 207RC0001X
FLME87340207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008YKOtherFLORIDA BLUE/BCBS OF FL
FL008YKOtherFLORIDA BLUE/BCBS OF FL