Healthcare Provider Details

I. General information

NPI: 1699714469
Provider Name (Legal Business Name): MARYLAND HEALTHCARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12070 OLD LINE CTR SUITE 100
WALDORF MD
20602-2513
US

IV. Provider business mailing address

PO BOX 2130
WALDORF MD
20604-2130
US

V. Phone/Fax

Practice location:
  • Phone: 301-705-7870
  • Fax: 301-705-9622
Mailing address:
  • Phone: 301-705-7870
  • Fax: 301-705-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD HAFT
Title or Position: PRESIDENT
Credential: MD
Phone: 301-705-7870