Healthcare Provider Details

I. General information

NPI: 1174800304
Provider Name (Legal Business Name): HEART CARE OF SOUTHERN MARYLAND LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7704 MATAPEAKE BUSINESS DR SUITE 325
BRANDYWINE MD
20613-3023
US

IV. Provider business mailing address

7704 MATAPEAKE BUSINESS DR SUITE 325
BRANDYWINE MD
20613-3023
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-5151
  • Fax: 240-244-5131
Mailing address:
  • Phone: 240-244-5151
  • Fax: 240-244-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROY LEIBOFF
Title or Position: PARTNER
Credential: M.D.
Phone: 240-244-5151