Provider Demographics
NPI:1174878581
Name:MARYLAND PEDIATRIC CARDIOLOGY CENTER
Entity type:Organization
Organization Name:MARYLAND PEDIATRIC CARDIOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MUBADDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-801-4202
Mailing Address - Street 1:3004 SENECA CHIEF TRL
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3004 SENECA CHIEF TRL
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1418
Practice Address - Country:US
Practice Address - Phone:443-801-4202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012469002080P0202X
MDD00403102080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF89193Medicare UPIN