Organization
MIDATLANTIC CARDIOTHORACIC & VASCULAR ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES AZYBUIKE ANENE (PRESIDENT OWNER)
(215) 785-9905
Entity
Organization
Contact information
Practice address
501 BATH ROAD, SUITE 215, BRISTOL, PA 19007
(215) 785-9905
(215) 785-6794
Mailing address
501 BATH ROAD, SUITE 215, BRISTOL, PA 19007
(215) 785-9905
(215) 785-6794
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
25MA06518800
NJ
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MD066370L
PA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001820720001
—
PA
01
—
012207
MEDICARE
NJ
01
—
0152107202
AMERICHOICE
—
01
—
0824589000
IBC
—
01
—
1125019
KEYSTONE MERCY HLTH PLAN
—
01
—
2372310
AETNA
—
01
—
8211867002
CIGNA
—
01
—
8438706
NJ MEDICAL ASSISTANCE
—
01
—
914465
HIGHMARK
—
Enumeration date
10/16/2006
Last updated
08/22/2020
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