Healthcare Provider Details

I. General information

NPI: 1215929369
Provider Name (Legal Business Name): THE HEART CENTER OF NORTHERN ANNE ARUNDEL COUNTY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 MADISON PARK DR
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

1417 MADISON PARK DR
GLEN BURNIE MD
21061-5613
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-6600
  • Fax: 410-768-3132
Mailing address:
  • Phone: 410-768-6600
  • Fax: 410-768-3132

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 Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC OKUN
Title or Position: PRESIDENT
Credential: MD
Phone: 410-768-6600