Provider Demographics
NPI:1114206802
Name:PREMIER CARDIOVASCULAR CARE LLC
Entity type:Organization
Organization Name:PREMIER CARDIOVASCULAR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIFUDIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-595-0356
Mailing Address - Street 1:2417 NICOL CIR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2907
Mailing Address - Country:US
Mailing Address - Phone:240-678-3751
Mailing Address - Fax:
Practice Address - Street 1:10756 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2513
Practice Address - Country:US
Practice Address - Phone:301-595-0356
Practice Address - Fax:301-595-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063586207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416855100Medicaid