Provider Demographics
NPI:1497704027
Name:ADDALA PATEL AND ASSOCIATES PC
Entity Type:Organization
Organization Name:ADDALA PATEL AND ASSOCIATES PC
Other - Org Name:SOUTHERN MARYLAND CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-868-1380
Mailing Address - Street 1:9135 PISCATAWAY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2549
Mailing Address - Country:US
Mailing Address - Phone:301-868-1380
Mailing Address - Fax:301-868-4514
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-868-1380
Practice Address - Fax:301-868-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12BBSOOtherBLUECROSS MARYLAND
DC038118900Medicaid
4051OtherBLUECROSS FEDERAL
MD409913300Medicaid
DCG02359Medicare PIN