Healthcare Provider Details

I. General information

NPI: 1356643035
Provider Name (Legal Business Name): ELLICOTT CITY PRIMARY CARE PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 LITTLE PATUXENT PARKWAY #200
COLUMBIA MD
21044
US

IV. Provider business mailing address

10910 LITTLE PATUXENT PARKWAY #200
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-2770
  • Fax: 410-997-0066
Mailing address:
  • Phone: 410-997-2770
  • Fax: 410-997-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD67217
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0067020
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0067020
License Number StateMD

VIII. Authorized Official

Name: NADEEM ANWAR HASHMI
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 410-997-2770