Provider Demographics
NPI:1508077439
Name:WELLSPRING CARDIAC CARE, P.A.
Entity Type:Organization
Organization Name:WELLSPRING CARDIAC CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SECADA-LOVIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-828-5323
Mailing Address - Street 1:22 WEST RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2326
Mailing Address - Country:US
Mailing Address - Phone:410-828-5323
Mailing Address - Fax:410-828-5337
Practice Address - Street 1:22 WEST RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2326
Practice Address - Country:US
Practice Address - Phone:410-828-5323
Practice Address - Fax:410-828-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty