Healthcare Provider Details

I. General information

NPI: 1164278735
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 RIVERSIDE DRIVE SUITE B102
SALISBURY MD
21801
US

IV. Provider business mailing address

2024 WEST STREET SUITE 304
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 443-598-2480
  • Fax: 443-598-2488
Mailing address:
  • Phone: 443-598-2480
  • Fax: 443-598-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES DANIEL TELEP
Title or Position: OWNER
Credential: M.D.
Phone: 443-598-2480