Healthcare Provider Details

I. General information

NPI: 1992860308
Provider Name (Legal Business Name): HEARTMASTERS MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE B205
CLINTON MD
20735-1628
US

IV. Provider business mailing address

1257 GERSTNER CT
GAMBRILLS MD
21054-1935
US

V. Phone/Fax

Practice location:
  • Phone: 307-877-4933
  • Fax: 301-877-6963
Mailing address:
  • Phone: 202-669-5821
  • Fax: 410-721-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM39287
License Number StateMD

VIII. Authorized Official

Name: DR. IEON LLOYD DAWSON
Title or Position: PHYSICIAN OWNER
Credential: M.D.,F.A.C.C.
Phone: 202-669-5821