MEDICARE: OM CARDIOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083125736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM CARDIOLOGY, LLC

Provider Business Mailing Address
First Line	:	910 WASHINGTON RD STE A
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5845
Country	:	US
Telephone Number	:	443-205-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 WASHINGTON RD STE A
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-5845
Country	:	US
Telephone Number	:	443-205-1111
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT AGENT
Name	:	DR. KETAN P PARIKH
Credential	:	MD
Telephone Number	:	443-205-1111

Provider Enumeration Date	:	10/21/2017
Last Update Date	:	12/16/2018

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