Provider Demographics
NPI:1992860308
Name:HEARTMASTERS MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HEARTMASTERS MEDICAL ASSOCIATES PC
Other - Org Name:HEART MASTERS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IEON
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACC
Authorized Official - Phone:202-669-5821
Mailing Address - Street 1:1257 GERSTNER CT
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1935
Mailing Address - Country:US
Mailing Address - Phone:202-669-5821
Mailing Address - Fax:410-721-4488
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:B205
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:307-877-4933
Practice Address - Fax:301-877-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM39287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG26606Medicare UPIN
MDG02607Medicare PIN
MDG01430Medicare PIN