NPIMap

Organization Active NPI

Elite Nuclear Cardio Diagnostics

  • Primary Care Clinic/Center
  • Upper Marlboro, MD
National Provider Identifier
1639441017
Registry record updated May 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D0026012 Issued in MD
Legal business name
ELITE NUCLEAR CARDIO DIAGNOSTICS
Practice address
3207 Barcroft Dr
Upper Marlboro, MD 20774-2581
Phone
(240) 899-5315
Fax
(301) 483-7099
NPI assigned
Feb 1, 2012
Last updated
May 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2013

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

Authorized official

Name
Mrs. Victoria Enyogai, ADMINISTRATION
Title
Credentialing Manager
Phone
(301) 483-7999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D0026012 MD Primary

Addresses

Primary practice location

3207 Barcroft Dr
Upper Marlboro, MD 20774-2581

Mailing address

3207 Barcoft Drive
Upper Marlboro, MD 20774
Phone (240) 899-5315

Other identifiers 1

IdentifierTypeStateIssuer
502474MedicaidMD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1639441017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3207 BARCOFT DRIVE",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "20774",
            "telephone_number": "240-899-5315",
            "fax_number": "301-483-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 BARCROFT DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207742581",
            "telephone_number": "240-899-5315",
            "fax_number": "301-483-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE NUCLEAR CARDIO DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "ENYOGAI",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "301-483-7999",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ADMINISTRATION"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0026012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502474",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; 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.