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General NPI Number Information
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NPI Number | 1861339178
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Entity Type | Organization
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Legal Business Name | HEART CENTER OF SOUTHERN MARYLAND LLP
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 11370 PEMBROOKE SQ
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City | WALDORF
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State | MD
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Zip | 20603-4842
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Country | US
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Telephone | 301-932-5890
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Fax | 301-645-6361
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Provider Business Mailing Address
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Address Line | PO BOX 316
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City | WALDORF
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State | MD
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Zip | 20604-0316
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Country | US
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Telephone | 301-932-5890
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Fax | 301-645-6361
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Authorized Official
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Title or Position | MANAGER
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Name | STACI L BOWLING
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Credential |
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Telephone | 301-932-5890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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