Provider Demographics
NPI:1871754952
Name:PEACE ARCH CARDIOLOGY, PC
Entity type:Organization
Organization Name:PEACE ARCH CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-594-4002
Mailing Address - Street 1:1215 OLD FAIRHAVEN PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7444
Mailing Address - Country:US
Mailing Address - Phone:360-594-4002
Mailing Address - Fax:360-594-4006
Practice Address - Street 1:1215 OLD FAIRHAVEN PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7444
Practice Address - Country:US
Practice Address - Phone:360-594-4002
Practice Address - Fax:360-594-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044996207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807261100Medicaid
1356365001OtherNPI
ID807261100Medicaid