Basic Information
Provider Information
NPI: 1194899021
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENDER
FirstName: SVEN
MiddleName: INGO
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 DEFENSE HWY
Address2: SUITE 100
City: ANNAPOLIS
State: MD
PostalCode: 214018943
CountryCode: US
TelephoneNumber: 4434813354
FaxNumber: 4434816515
Practice Location
Address1: 2002 MEDICAL PKWY
Address2: SUITE 310
City: ANNAPOLIS
State: MD
PostalCode: 214013046
CountryCode: US
TelephoneNumber: 4102242400
FaxNumber: 4102244232
Other Information
ProviderEnumerationDate: 11/20/2006
LastUpdateDate: 01/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0001XD57994MDY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

ID Information
IDTypeStateIssuerDescription
0938000301DCGHIOTHER
AT54000801MDBCBSOTHER
46310210005MD MEDICAID


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