Provider Demographics
NPI:1386410801
Name:GOODWILL CARDIOLOGY CLINIC LLC
Entity type:Organization
Organization Name:GOODWILL CARDIOLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASAQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-985-3140
Mailing Address - Street 1:7100 BALTIMORE AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3641
Mailing Address - Country:US
Mailing Address - Phone:301-985-3140
Mailing Address - Fax:
Practice Address - Street 1:7100 BALTIMORE AVE STE 509
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3641
Practice Address - Country:US
Practice Address - Phone:301-985-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty