Healthcare Provider Details

I. General information

NPI: 1811180433
Provider Name (Legal Business Name): MARYLAND HEART ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEST RD BUILDING A, SUITE 201
BALTIMORE MD
21204-2316
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-307-1090
  • Fax: 410-307-1095
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0022633
License Number StateMD

VIII. Authorized Official

Name: JORGE C. SECADA-LOVIO
Title or Position: M.D.
Credential: M.D.
Phone: 410-828-5323