Minimally Invasive Vascular Center of Maryland LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

H0065639 Issued in MD

Legal business name

MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND LLC

Practice address

8730 Cherry Lane
Suite 10
Laurel, MD 20707

Phone

(301) 497-1590

Fax

(240) 334-4781

NPI assigned

Mar 18, 2009

Organization subpart

No

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

Authorized official

Name

Wendy L Muhammad

Title

President

Phone

(301) 497-1590

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Mivc ASC, LLC

  • Ambulatory Surgical Clinic/Center
  • Laurel, MD
  • NPI 1174074538
  NPPES parent name

Practitioners 1

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

• Euphemia R Brumskine, MD

  • Family Medicine Physician
  • Laurel, MD
  • NPI 1336259894
  NPD (past)

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

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1457592685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8730 CHERRY LN STE 10",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207076212",
            "telephone_number": "301-497-1590",
            "fax_number": "240-334-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8730 CHERRY LANE",
            "address_2": "SUITE 10",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "20707",
            "telephone_number": "301-497-1590",
            "fax_number": "240-334-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIMALLY INVASIVE VASCULAR CENTER OF MARYLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2021-02-08",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "MUHAMMAD",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-497-1590"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MD",
            "license": "H0065639",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MD",
            "license": "H0065639",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "DC",
            "license": "D0034245",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031107300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054737700",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Laurel, MD
• Vascular Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.