Healthcare Provider Details

I. General information

NPI: 1205826948
Provider Name (Legal Business Name): MOSAM CARDIOVASCULAR SURGERY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR 4TH FLOOR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

6510 KENILWORTH AVE #2500
RIVERDALE MD
20737-1339
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-2089
  • Fax: 301-618-6490
Mailing address:
  • Phone: 301-618-2089
  • Fax: 301-618-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD ALI NOFICY
Title or Position: MD
Credential: MD
Phone: 301-618-2089