Provider Demographics
NPI:1346339736
Name:MARYLAND VASCULAR ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MARYLAND VASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZATINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-646-4888
Mailing Address - Street 1:3350 WILKENS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4600
Mailing Address - Country:US
Mailing Address - Phone:410-646-4888
Mailing Address - Fax:410-646-2828
Practice Address - Street 1:3350 WILKENS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4600
Practice Address - Country:US
Practice Address - Phone:410-646-4888
Practice Address - Fax:410-646-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty