NPIMap

Organization Active NPI

Premier Vascular Center of Maryland LLC

  • Vascular Surgery Physician
  • Towson, MD
National Provider Identifier
1104335439
Registry record updated Sep 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
PREMIER VASCULAR CENTER OF MARYLAND LLC
Practice address
7801 York Road
Suite 240
Towson, MD 21286
Phone
(410) 323-9214
Fax
(410) 323-9215
NPI assigned
Sep 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mouhamad O. Annous, M.D.NPI 1154390953
Title
President
Phone
(410) 323-9214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

7801 York Road
Suite 240
Towson, MD 21286

Mailing address

1900 E Northern Pkwy Ste 209
Baltimore, MD 21239-2110
Phone (410) 323-9214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180718001231 MD Part B Supplier - Clinic/Group Practice 3476800798 Receives reassigned benefits from 4 practitioners
Practice locations: Towson, MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506643200000",
    "number": "1104335439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 E NORTHERN PKWY STE 209",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392110",
            "telephone_number": "410-323-9214",
            "fax_number": "410-323-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 YORK ROAD",
            "address_2": "SUITE 240",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "21286",
            "telephone_number": "410-323-9214",
            "fax_number": "410-323-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER VASCULAR CENTER OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2017-09-29",
        "status": "A",
        "authorized_official_last_name": "ANNOUS",
        "authorized_official_first_name": "MOUHAMAD",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-323-9214",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.