Healthcare Provider Details

I. General information

NPI: 1366491557
Provider Name (Legal Business Name): MAIDEN CHOICE CARDIAC DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 MAIDEN CHOICE LN SUITE 203
BALTIMORE MD
21228-5911
US

IV. Provider business mailing address

724 MAIDEN CHOICE LN SUITE 203
BALTIMORE MD
21228-5911
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-0200
  • Fax: 410-455-0009
Mailing address:
  • Phone: 410-455-0200
  • Fax: 410-455-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: HOMAYOON MOGHBELI
Title or Position: MD
Credential: MD
Phone: 410-455-0200