# CARDIOVASCULAR CENTER OF AMERICA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063975175
- **Authorized official:** JAMES O'DARE III (PRINCIPAL)
- **Authorized official phone:** (856) 335-5025

## Contact information

- **Practice address:** 404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
- **Practice address phone:** (856) 335-5025
- **Practice address fax:** (856) 213-9269
- **Mailing address:** 575 N ROUTE 73 STE A6, WEST BERLIN, NJ 08091-2440
- **Mailing address phone:** (856) 335-5025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/08/2019
- **Last updated:** 04/08/2019