Provider Demographics
NPI:1275723488
Name:CARDIO VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:CARDIO VASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:HABIB
Authorized Official - Last Name:FADUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-870-3626
Mailing Address - Street 1:6228 OXON HILL RD
Mailing Address - Street 2:P.O. BOX 1098
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3033
Mailing Address - Country:US
Mailing Address - Phone:301-870-3626
Mailing Address - Fax:301-392-6978
Practice Address - Street 1:6228 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3033
Practice Address - Country:US
Practice Address - Phone:301-870-3626
Practice Address - Fax:301-392-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015765261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD172300600Medicaid
VA000100153Medicaid
DC026722100Medicaid
MDFMCUV9Medicare PIN
MDFMCUV8Medicare PIN
DCFDCUV6Medicare PIN
DC026722100Medicaid
VA000100153Medicaid