Healthcare Provider Details

I. General information

NPI: 1205835485
Provider Name (Legal Business Name): WASHINGTON CARDIOVASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVE STE 100
TAKOMA PARK MD
20912-6311
US

IV. Provider business mailing address

7610 CARROLL AVE SUITE 100
TAKOMA PARK MD
20912
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-2500
  • Fax: 301-891-1704
Mailing address:
  • Phone: 301-891-2500
  • Fax: 301-891-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD42222
License Number StateMD

VIII. Authorized Official

Name: MUBASHAR A. CHOUDRY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-891-2500