Healthcare Provider Details

I. General information

NPI: 1871165092
Provider Name (Legal Business Name): CHARM CITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/02/2025
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 REISTERSTOWN RD
BALTIMORE MD
21217-1928
US

IV. Provider business mailing address

6041 WINTER GRAIN PATH
CLARKSVILLE MD
21029-1224
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-1296
  • Fax: 443-535-0773
Mailing address:
  • Phone: 301-646-3279
  • Fax: 443-535-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVESH DHRUVA KANJARPANE
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 301-646-3279