Provider Demographics
NPI:1205826948
Name:MOSAM CARDIOVASCULAR SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MOSAM CARDIOVASCULAR SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:NOFICY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-618-2089
Mailing Address - Street 1:6510 KENILWORTH AVE
Mailing Address - Street 2:#2500
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1339
Mailing Address - Country:US
Mailing Address - Phone:301-618-2089
Mailing Address - Fax:301-618-6490
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:301-618-2089
Practice Address - Fax:301-618-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01876Medicare ID - Type Unspecified
Y28426Medicare UPIN