Provider Demographics
NPI:1710025424
Name:CARDIOSONICS INC
Entity type:Organization
Organization Name:CARDIOSONICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GAHARA
Authorized Official - Suffix:
Authorized Official - Credentials:CVT, RDCS
Authorized Official - Phone:603-533-9771
Mailing Address - Street 1:497 HOOKSETT RD # 2 SUITE 393
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2632
Mailing Address - Country:US
Mailing Address - Phone:603-533-9771
Mailing Address - Fax:603-668-4052
Practice Address - Street 1:258 SAGAMORE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3305
Practice Address - Country:US
Practice Address - Phone:603-533-9771
Practice Address - Fax:603-668-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCVT-NATIONAL246W00000X, 246XC2903X
MACVT-NATIONAL246X00000X
NH246Z00000X
NH20331246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH617130OtherCIGNA HEALTHCARE
NH327030OtherMARTIN'S POINT HEALTHCARE
NH626186OtherHARVARD PILGRIM HEALTH
NH30810896Medicaid
NH30810896Medicaid