Provider Demographics
NPI:1669451175
Name:HEART CENTER OF SOUTHERN MARYLAND, L.L.P.
Entity Type:Organization
Organization Name:HEART CENTER OF SOUTHERN MARYLAND, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:
Authorized Official - First Name:GOPALAKRISHNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-932-5890
Mailing Address - Street 1:3510 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3233
Mailing Address - Country:US
Mailing Address - Phone:301-870-6002
Mailing Address - Fax:301-843-7783
Practice Address - Street 1:3510 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3233
Practice Address - Country:US
Practice Address - Phone:301-870-6002
Practice Address - Fax:301-843-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC6769OtherRAILROAD MEDICARE
CJ4451OtherRAILROAD MEDICARE
MD040196000Medicaid
MD040196000Medicaid
MD335LMedicare PIN