Healthcare Provider Details

I. General information

NPI: 1114321767
Provider Name (Legal Business Name): CHARM CITY PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 06/13/2024
Certification Date: 02/08/2024
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 STE #1F
CLARKSVILLE MD
21029-1224
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberD0040076
License Number StateMD

VIII. Authorized Official

Name: DR. DEVESH DHRUVA KANJARPANE
Title or Position: CHIEF MEDICAL OFFICER (CMO)
Credential: MD MPH FACPM FACOEM
Phone: 301-675-1296