Provider Demographics
NPI:1770609653
Name:HEART CENTER AT MT.AIRY
Entity type:Organization
Organization Name:HEART CENTER AT MT.AIRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:KOJO
Authorized Official - Last Name:AMEGASHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-420-0822
Mailing Address - Street 1:1219 MT. AETNA RD
Mailing Address - Street 2:STE 201
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742
Mailing Address - Country:US
Mailing Address - Phone:240-420-0822
Mailing Address - Fax:240-420-0826
Practice Address - Street 1:1219 MOUNT AETNA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6550
Practice Address - Country:US
Practice Address - Phone:124-042-0082
Practice Address - Fax:240-420-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG42857Medicare UPIN