Provider Demographics
NPI:1295961027
Name:CARDIOVASCULAR DIAGNOSTIC CENTER, PA
Entity type:Organization
Organization Name:CARDIOVASCULAR DIAGNOSTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHWANI
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-863-8860
Mailing Address - Street 1:325 HOSPITAL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5860
Mailing Address - Country:US
Mailing Address - Phone:410-863-8860
Mailing Address - Fax:410-766-7305
Practice Address - Street 1:325 HOSPITAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5860
Practice Address - Country:US
Practice Address - Phone:410-863-8860
Practice Address - Fax:410-766-7305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR DIAGNOSTIC CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD37250207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE66161Medicare UPIN