Healthcare Provider Details

I. General information

NPI: 1881701175
Provider Name (Legal Business Name): PATUXENT CARDIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 SOLOMONS ISLAND RD
HUNTINGTOWN MD
20639-8732
US

IV. Provider business mailing address

2419 SOLOMONS ISLAND RD
HUNTINGTOWN MD
20639-8732
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-3612
  • Fax: 410-535-3613
Mailing address:
  • Phone: 410-535-3612
  • Fax: 410-535-3613

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 Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VARKEY MATHEW
Title or Position: OWNER
Credential: M.D.
Phone: 410-535-3612