Healthcare Provider Details

I. General information

NPI: 1669451175
Provider Name (Legal Business Name): HEART CENTER OF SOUTHERN MARYLAND, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 OLD WASHINGTON RD SUITE 100
WALDORF MD
20602-3233
US

IV. Provider business mailing address

3510 OLD WASHINGTON RD SUITE 100
WALDORF MD
20602-3233
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-6002
  • Fax: 301-843-7783
Mailing address:
  • Phone: 301-870-6002
  • Fax: 301-843-7783

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 Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GOPALAKRISHNAN SRINIVASAN
Title or Position: OWNER/M.D.
Credential: M.D.
Phone: 301-932-5890