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General NPI Number Information
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NPI Number | 1174878581
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Entity Type | Organization
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Legal Business Name | MARYLAND PEDIATRIC CARDIOLOGY CENTER
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 3004 SENECA CHIEF TRL
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-1418
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Country | US
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Telephone | 443-801-4202
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 SENECA CHIEF TRL
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-1418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MUBADDA SALIM
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Credential | M.D.
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Telephone | 443-801-4202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101246900
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | D0040310
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License Number State | MD
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