Provider Demographics
NPI:1447255492
Name:EASTERN SHORE CARDIOVASCULAR ASSOC. P.A.
Entity type:Organization
Organization Name:EASTERN SHORE CARDIOVASCULAR ASSOC. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARIKISAN
Authorized Official - Middle Name:RAMBILAS
Authorized Official - Last Name:HEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-749-5419
Mailing Address - Street 1:614 EASTERN SHORE DR
Mailing Address - Street 2:# D
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5955
Mailing Address - Country:US
Mailing Address - Phone:410-749-5419
Mailing Address - Fax:410-749-1047
Practice Address - Street 1:614 EASTERN SHORE DR
Practice Address - Street 2:# D
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5955
Practice Address - Country:US
Practice Address - Phone:410-749-5419
Practice Address - Fax:410-749-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD097NMedicare PIN