Healthcare Provider Details

I. General information

NPI: 1487235131
Provider Name (Legal Business Name): GREAT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9129 TRAVENER CIR
FREDERICK MD
21704-7824
US

IV. Provider business mailing address

9129 TRAVENER CIR
FREDERICK MD
21704-7824
US

V. Phone/Fax

Practice location:
  • Phone: 202-964-3632
  • Fax: 240-238-6613
Mailing address:
  • Phone: 202-964-3632
  • Fax: 240-238-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRAN SAMINDLA
Title or Position: CEO/MD/PHYSICIAN
Credential: MD
Phone: 202-964-3632