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NPI Code Detail

MEDICARE: CENTENNIAL MEDICAL GROUP, PA

MEDICARE: CENTENNIAL MEDICAL GROUP, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing Site
2207KA0200XAllergy Physician
3207P00000XEmergency Medicine Physician
4208100000XPhysical Medicine & Rehabilitation Physician
52083X0100XOccupational Medicine Physician
6208D00000XGeneral Practice Physician
7207R00000XInternal Medicine Physician
8207RA0201XAllergy & Immunology (Internal Medicine) Physician
9207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2R481OTHERMDBCBS

General Provider Information

NPI Number : 1134235039
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTENNIAL MEDICAL GROUP, PA
Provider Business Mailing Address
First Line : 6230 OLD DOBBIN LN STE 230
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5884
Country : US
Telephone Number : 410-730-3399
Fax Number : 443-478-4737
Provider Business Practice Location Address
First Line : 6250 OLD DOBBIN LN
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5816
Country : US
Telephone Number : 410-730-3399
Fax Number : 443-478-4737
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. RAJIV DUA
Credential : MD
Telephone Number : 410-730-3399
Provider Enumeration Date : 08/22/2006
Last Update Date : 09/18/2024

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1043326945 — DR. RAJIV DUA M.D.
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Practice Fax: 443-478-4737
1023124922 — DR. JOSEPH F GIBBONS M.D.
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21045-5816
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Practice Location Address:
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21045-5816
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Directions to “CENTENNIAL MEDICAL GROUP, PA ” Practice Location

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