Provider Demographics
NPI:1992101356
Name:CARDIOVASCULAR SPECIALISTS OF GERMANTOWN LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF GERMANTOWN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEKURIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-494-6884
Mailing Address - Street 1:15547 OWENS GLEN TER
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2358
Mailing Address - Country:US
Mailing Address - Phone:240-494-6884
Mailing Address - Fax:301-363-4367
Practice Address - Street 1:12800 MIDDLEBROOK RD
Practice Address - Street 2:SUITE # 114
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5204
Practice Address - Country:US
Practice Address - Phone:240-494-6884
Practice Address - Fax:301-363-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69671207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861650111OtherTYPE 1, NPI