Healthcare Provider Details

I. General information

NPI: 1518891787
Provider Name (Legal Business Name): CENTRAL PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 LIBERTY RD
ELDERSBURG MD
21784-7934
US

IV. Provider business mailing address

1137 LIBERTY RD
ELDERSBURG MD
21784-7934
US

V. Phone/Fax

Practice location:
  • Phone: 214-815-7595
  • Fax:
Mailing address:
  • Phone: 214-815-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL KEBEDE
Title or Position: PHYSICIAN
Credential: MD
Phone: 214-815-7595