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General NPI Number Information
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NPI Number | 1457592685
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND LLC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 8730 CHERRY LANE SUITE 10
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City | LAUREL
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State | MD
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Zip | 20707
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Country | US
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Telephone | 301-497-1590
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Fax | 240-334-4781
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Provider Business Mailing Address
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Address Line | 8730 CHERRY LN STE 10
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City | LAUREL
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State | MD
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Zip | 20707-6212
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Country | US
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Telephone | 301-497-1590
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Fax | 240-334-4781
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Authorized Official
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Title or Position | PRESIDENT
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Name | WENDY L MUHAMMAD
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Credential |
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Telephone | 301-497-1590
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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 | H0065639
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D0034245
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | H0065639
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License Number State | MD
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