Provider Demographics
NPI:1356400204
Name:HEARTFELT MEDICAL GROUP L L C
Entity type:Organization
Organization Name:HEARTFELT MEDICAL GROUP L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-837-2006
Mailing Address - Street 1:301 SAINT PAUL PL
Mailing Address - Street 2:SUITE 509
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-837-2006
Mailing Address - Fax:410-244-8510
Practice Address - Street 1:301 ST PAUL PL
Practice Address - Street 2:SUITE 509
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:410-837-2006
Practice Address - Fax:410-244-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187761500Medicaid
421L067CMedicare PIN
MD187761500Medicaid