Provider Demographics
NPI:1467645580
Name:OM CARDIOVASCULAR, P.C.
Entity Type:Organization
Organization Name:OM CARDIOVASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:PRAVINCHANDRA
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-876-4477
Mailing Address - Street 1:295 STONER AVE
Mailing Address - Street 2:BILLINGSLEA BLDG., SUITE 203
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5698
Mailing Address - Country:US
Mailing Address - Phone:410-876-4477
Mailing Address - Fax:410-876-4677
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:BILLINGSLEA BLDG., SUITE 203
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-876-4477
Practice Address - Fax:410-876-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061452174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH39468Medicare UPIN