Provider Demographics
NPI:1164278735
Name:PEDIATRIC CARDIOLOGY OF MARYLAND
Entity type:Organization
Organization Name:PEDIATRIC CARDIOLOGY OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TELEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-598-2480
Mailing Address - Street 1:2024 WEST STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:443-598-2480
Mailing Address - Fax:443-598-2488
Practice Address - Street 1:560 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE B102
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:443-598-2480
Practice Address - Fax:443-598-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD559005101Medicaid