Healthcare Provider Details

I. General information

NPI: 1679507297
Provider Name (Legal Business Name): MARYLAND PULMONARY & CRITICAL CARE GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CRAIN HWY S SUITE 308
GLEN BURNIE MD
21061-5577
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-5510
  • Fax: 410-760-5925
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMAL BATCHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-335-0008