Provider Demographics
NPI:1669495628
Name:ADVANCED CARDIOLOGY CENTER
Entity Type:Organization
Organization Name:ADVANCED CARDIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-816-9000
Mailing Address - Street 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-816-9000
Mailing Address - Fax:301-816-0295
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-816-9000
Practice Address - Fax:301-816-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD109041100Medicaid
MD034789Medicare ID - Type Unspecified