Heart Center of Southern Maryland

NPI #1568917383 in Waldorf, Maryland

Provider Information

NPI Number: 1568917383
Entity Type: Organization
Organization Name: Heart Center of Southern Maryland
Primary Specialty: Physician Assistant
Enumeration Date: Aug 22, 2016
Last Updated: Aug 22, 2016

Practice Location

Address: 3510 OLD WASHINGTON RD
Address 2: SUITE 100
City: Waldorf
State: Maryland
ZIP Code: 20602-3233
Phone: (301) 645-4793

Authorized Official

Name: GOPALAKRISHNAN SRINIVASAN, M.D
Title: CEO
Phone: (301) 645-4793

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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