1598190993 NPI number — ROCKVILLE CARDIOLOGY CENTER PC

Table of content: (NPI 1598190993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598190993 NPI number — ROCKVILLE CARDIOLOGY CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKVILLE CARDIOLOGY CENTER PC
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:
1598190993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11103 WELLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-4862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-768-0552
Provider Business Mailing Address Fax Number:
301-933-7002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12001 FERRARA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20906-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-768-0552
Provider Business Practice Location Address Fax Number:
301-933-7002
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ABBASI
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
301-768-0552

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D0044155 , 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)

  • Identifier: 409046200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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