Provider Demographics
NPI:1598944761
Name:C. NAGANNA MD, PA
Entity Type:Organization
Organization Name:C. NAGANNA MD, PA
Other - Org Name:CARROLL HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMALATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-848-5250
Mailing Address - Street 1:700A POOLE RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7229
Mailing Address - Country:US
Mailing Address - Phone:410-848-5250
Mailing Address - Fax:410-848-5375
Practice Address - Street 1:700A POOLE RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7229
Practice Address - Country:US
Practice Address - Phone:410-848-5250
Practice Address - Fax:410-848-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD277041500Medicaid
190LMedicare PIN