Healthcare Provider Details

I. General information

NPI: 1134120793
Provider Name (Legal Business Name): RITA KRISHAN DHAWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8516 TIMBER VALLEY CT
ELLICOTT CITY MD
21043-6065
US

IV. Provider business mailing address

9055 CHEVROLET DRIVE SUITE 103
ELLICOTT CITY MD
21042
US

V. Phone/Fax

Practice location:
  • Phone: 410-461-8781
  • Fax: 410-461-8781
Mailing address:
  • Phone: 410-461-8781
  • Fax: 410-461-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0062534
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: