Healthcare Provider Details

I. General information

NPI: 1164609111
Provider Name (Legal Business Name): GASTRO CENTER OF MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 MINSTREL WAY SUITE 100
COLUMBIA MD
21045-5248
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:
Mailing address:
  • Phone: 410-290-6677
  • Fax: 410-290-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0044427
License Number StateMD

VIII. Authorized Official

Name: DR. RUDRA RAI
Title or Position: OWNER/ PRESIDENT
Credential: MD
Phone: 410-290-6677