Healthcare Provider Details

I. General information

NPI: 1720479728
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH & ADDICTION SERVICES OF HOWARD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 BENSON AVE STE # 101
HALETHORPE MD
21227-1530
US

IV. Provider business mailing address

6041 WINTER GRAIN PATH STE # 1H
CLARKSVILLE MD
21029-1224
US

V. Phone/Fax

Practice location:
  • Phone: 443-524-2737
  • Fax: 443-524-2742
Mailing address:
  • Phone: 301-675-1296
  • Fax: 443-535-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD40076
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberD40076
License Number StateMD

VIII. Authorized Official

Name: DR. DEVESH DHRUVA KANJARPANE
Title or Position: PRESIDENT
Credential: MD MPH FACPM
Phone: 301-675-1296