Organization
PEDIATRIC CARDIOLOGY ASSOC PA
Active
Organization
PEDIATRIC CARDIOLOGY ASSOC PA
Active
Other names
CONGENITAL HEART
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON PATRICK DONNELLY MD (PRESIDENT)
(207) 883-5532
Entity
Organization
Contact information
Practice address
71 US ROUTE 1, SUITE C, SCARBOROUGH, ME 04074-7173
(207) 883-5532
(207) 883-5552
Mailing address
71 US ROUTE 1, SUITE C, SCARBOROUGH, ME 04074-7173
(207) 883-5532
(207) 883-5552
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
014324
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112590000
—
ME
05
—
30004962
—
NH
Enumeration date
11/13/2006
Last updated
08/28/2017
Update your record
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