1992101356 NPI number — CARDIOVASCULAR SPECIALISTS OF GERMANTOWN LLC

Table of content: (NPI 1992101356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992101356 NPI number — CARDIOVASCULAR SPECIALISTS OF GERMANTOWN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR SPECIALISTS OF GERMANTOWN LLC
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:
6
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:
1992101356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15547 OWENS GLEN TER
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:
20878-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-494-6884
Provider Business Mailing Address Fax Number:
301-363-4367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12800 MIDDLEBROOK RD
Provider Second Line Business Practice Location Address:
SUITE # 114
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-494-6884
Provider Business Practice Location Address Fax Number:
301-363-4367
Provider Enumeration Date:
11/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MEKURIA
Authorized Official First Name:
SARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
240-494-6884

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  D69671 , 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: 1861650111 . This is a "TYPE 1, NPI" identifier . This identifiers is of the category "OTHER".




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