Healthcare Provider Details

I. General information

NPI: 1447680137
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021B EMMORTON RD STE 110
BEL AIR MD
21015-8965
US

IV. Provider business mailing address

602 S ATWOOD RD SUITE 100
BEL AIR MD
21014-4172
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-9950
  • Fax: 410-638-9956
Mailing address:
  • Phone: 410-877-7777
  • Fax: 410-638-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: MARY WRIGHT-SISK
Title or Position: DIRECTOR
Credential:
Phone: 443-422-9941