Healthcare Provider Details

I. General information

NPI: 1558408260
Provider Name (Legal Business Name): ARAVINDAN KOLANDAIVELU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

6201 GREENLEIGH AVENUE
BALTIMORE MD
21264-4250
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-1973
  • Fax: 410-550-0012
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD71260
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD71260
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: