Healthcare Provider Details

I. General information

NPI: 1346339736
Provider Name (Legal Business Name): MARYLAND VASCULAR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 WILKENS AVE SUITE 100
BALTIMORE MD
21229-4600
US

IV. Provider business mailing address

3350 WILKENS AVE SUITE 100
BALTIMORE MD
21229-4600
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-4888
  • Fax: 410-646-2828
Mailing address:
  • Phone: 410-646-4888
  • Fax: 410-646-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0043877
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL A. ZATINA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-646-4888