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
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