Healthcare Provider Details

I. General information

NPI: 1912021619
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 SHADY GROVE RD SUITE 306
ROCKVILLE MD
20850-3235
US

IV. Provider business mailing address

15215 SHADY GROVE ROAD SUITE 306
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-990-0040
  • Fax: 301-990-0043
Mailing address:
  • Phone: 301-990-0040
  • Fax: 301-990-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0007966
License Number StateMD

VIII. Authorized Official

Name: MS. JOYCE A. WATSON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 301-990-0040