Midatlantic Cardiothoracic & Vascular Assoc

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

MD066370L Issued in PA

Legal business name

MIDATLANTIC CARDIOTHORACIC & VASCULAR ASSOC

Practice address

501 Bath Road
Suite 215
Bristol, PA 19007

Phone

(215) 785-9905

Fax

(215) 785-6794

NPI assigned

Oct 16, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Azybuike Anene

Title

President Owner

Phone

(215) 785-9905

Specialties & licenses 3

Addresses

Other identifiers 10

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770663957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 BATH ROAD",
            "address_2": "SUITE 215",
            "city": "BRISTOL",
            "state": "PA",
            "postal_code": "19007",
            "telephone_number": "215-785-9905",
            "fax_number": "215-785-6794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BATH ROAD",
            "address_2": "SUITE 215",
            "city": "BRISTOL",
            "state": "PA",
            "postal_code": "19007",
            "telephone_number": "215-785-9905",
            "fax_number": "215-785-6794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDATLANTIC CARDIOTHORACIC & VASCULAR ASSOC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANENE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "AZYBUIKE",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "215-785-9905"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NJ",
            "license": "25MA06518800",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD066370L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HLTH PLAN",
            "identifier": "1125019",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "914465",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC",
            "identifier": "0824589000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ MEDICAL ASSISTANCE",
            "identifier": "8438706",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001820720001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "012207",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "0152107202",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0824589000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2372310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8211867002",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Bristol, PA
• Providers in Bristol, PA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.