Healthcare Provider Details

I. General information

NPI: 1700719564
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY CARE AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD STE 150
ROCKVILLE MD
20850-7210
US

IV. Provider business mailing address

15245 SHADY GROVE RD STE 340
ROCKVILLE MD
20850-7201
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-9776
  • Fax: 301-417-4947
Mailing address:
  • Phone: 301-869-9776
  • Fax: 301-417-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KONSTANTIN A KHLUDENEV
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 301-869-9776