Healthcare Provider Details

I. General information

NPI: 1336083591
Provider Name (Legal Business Name): GASTRO CENTER OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY STE 204
COLUMBIA MD
21045-5292
US

IV. Provider business mailing address

7120 MINSTREL WAY STE 100
COLUMBIA MD
21045-5274
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-6677
  • Fax: 410-290-6676
Mailing address:
  • Phone: 410-290-6677
  • Fax: 410-290-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: RUDRAJIT MASAND RAI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 410-290-6677