1295961027 NPI number — CARDIOVASCULAR DIAGNOSTIC CENTER, PA

Table of content: (NPI 1295961027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295961027 NPI number — CARDIOVASCULAR DIAGNOSTIC CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR DIAGNOSTIC CENTER, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295961027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-5860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-863-8860
Provider Business Mailing Address Fax Number:
410-766-7305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-5860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-863-8860
Provider Business Practice Location Address Fax Number:
410-766-7305
Provider Enumeration Date:
06/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASSI
Authorized Official First Name:
ASHWANI
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESEIDENT
Authorized Official Telephone Number:
410-863-8860

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD37250 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)