Organization
PENNSYLVANIA CARDIOTHORACIC SURGERY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D. HAROSTOCK MD (PRESIDENT)
(570) 270-4455
Entity
Organization
Contact information
Practice address
545 N RIVER ST, SUITE 130, WILKES BARRE, PA 18702-2600
(570) 270-4455
(570) 270-4884
Mailing address
545 N RIVER ST, SUITE 130, WILKES BARRE, PA 18702-2600
(570) 270-4455
(570) 270-4884
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD028903E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009611590006
—
PA
05
—
0018673110002
—
PA
01
—
780002061
RR MEDICARE
PA
01
—
CJ3345
RR MEDICARE (GROUP)
PA
Enumeration date
07/13/2005
Last updated
10/13/2014
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