MEDICARE: MOSAM CARDIOVASCULAR SURGERY ASSOCIATES 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1205826948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAM CARDIOVASCULAR SURGERY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	6510 KENILWORTH AVE
Second Line	:	#2500
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1339
Country	:	US
Telephone Number	:	301-618-2089
Fax Number	:	301-618-6490

Provider Business Practice Location Address
First Line	:	3001 HOSPITAL DR
Second Line	:	4TH FLOOR
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1189
Country	:	US
Telephone Number	:	301-618-2089
Fax Number	:	301-618-6490

Authorized Official
Title or Position	:	MD
Name	:	MOHAMMAD ALI NOFICY
Credential	:	MD
Telephone Number	:	301-618-2089

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/22/2020

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