Provider Demographics
NPI:1164821955
Name:PEDIATRIC CARDIOLOGY OF MARYLAND
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TELEP M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-598-2480
Mailing Address - Street 1:2024 WEST STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0001
Mailing Address - Country:US
Mailing Address - Phone:443-598-2480
Mailing Address - Fax:443-598-2488
Practice Address - Street 1:2024 WEST STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-0001
Practice Address - Country:US
Practice Address - Phone:443-598-2480
Practice Address - Fax:443-598-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty