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CARDIOVASCULAR SPECIALISTS OF CENTRAL MARYLAND
Complete NPI Record 1609195320
Internal Medicine - Cardiovascular Disease in Columbia, MD

NPI Status: Active since May 20, 2010

Contact Information

10710 CHARTER DR
STE 400
COLUMBIA, MD
ZIP 21044
Phone: (443) 276-9000
Fax: (443) 276-9610

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Second Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Healthcare Provider Primary Taxonomy Switch 3
  33. Other Provider Identifier 1
  34. Other Provider Identifier Type Code 1
  35. Other Provider Identifier State 1
  36. Other Provider Identifier Issuer 1
  37. Other Provider Identifier 2
  38. Other Provider Identifier Type Code 2
  39. Other Provider Identifier State 2
  40. Other Provider Identifier Issuer 2
  41. Other Provider Identifier 3
  42. Other Provider Identifier Type Code 3
  43. Other Provider Identifier State 3
  44. Other Provider Identifier 4
  45. Other Provider Identifier Type Code 4
  46. Other Provider Identifier State 4
  47. Other Provider Identifier Issuer 4
  48. Is Organization Subpart
  49. Parent Organization LBN
  50. Parent Organization TIN
  51. Healthcare Provider Taxonomy Group 1
  52. Healthcare Provider Taxonomy Group 2
  53. Healthcare Provider Taxonomy Group 3
  54. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1609195320. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1609195320
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Entity Type Code: 2
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: CARDIOVASCULAR SPECIALISTS OF CENTRAL MARYLAND
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: PO BOX 412709
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: BOSTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 022412709
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 4107608840
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 10710 CHARTER DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: STE 400
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: COLUMBIA
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MD
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 21044
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4432769000
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4432769610
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/20/2010
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/20/2024
The date that a record was last updated or changed.
Authorized Official Last Name: MARTUCCI
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: KRISTI
The first name of the authorized official.
Authorized Official Title or Position: JHRP BILLING MANAGER
The title or position of the authorized official.
Authorized Official Telephone Number: 4107608840
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RC0000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 207RC0001X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207RI0011X
Healthcare Provider Primary Taxonomy Switch 3: N
Other Provider Identifier 1: CRZ1CA
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: MD
Other Provider Identifier Issuer 1: CAREFIRST OF MARYLAND
Other Provider Identifier 2: V879
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: MD
Other Provider Identifier Issuer 2: CAREFIRST GHMSI AND BLUE CHOICE
Other Provider Identifier 3: 440200600
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: MD
Other Provider Identifier 4: DR1793
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: MD
Other Provider Identifier Issuer 4: RAILROAD MEDICARE
Is Organization Subpart: Y
Parent Organization LBN: JOHNS HOPKINS REGIONAL PHYSICIANS LLC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 3/20/2024