Provider Demographics
NPI:1972504686
Name:THE CARDIOLOGY GROUP PC
Entity type:Organization
Organization Name:THE CARDIOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-773-3055
Mailing Address - Street 1:1952 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1209
Mailing Address - Country:US
Mailing Address - Phone:203-773-3055
Mailing Address - Fax:203-281-5796
Practice Address - Street 1:1952 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-773-3055
Practice Address - Fax:203-281-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004090594Medicaid
CT004090594Medicaid