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General NPI Number Information
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NPI Number | 1396915906
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Entity Type | Organization
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Legal Business Name | OM CARDIOVASCULAR, LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 295 STONER AVE SUITE 203
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City | WESTMINSTER
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State | MD
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Zip | 21157-5698
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Country | US
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Telephone | 410-871-9800
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Fax | 410-871-9801
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Provider Business Mailing Address
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Address Line | 295 STONER AVE SUITE 203
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City | WESTMINSTER
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State | MD
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Zip | 21157-5698
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Country | US
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Telephone | 410-871-9800
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Fax | 410-871-9801
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Authorized Official
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Title or Position | M.D.
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Name | DR. KETAN PRAVINCHANDRA PARIKH
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Credential |
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Telephone | 410-871-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0061452
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License Number State | MD
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