Healthcare Provider Details

I. General information

NPI: 1699170894
Provider Name (Legal Business Name): DHURVACARE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 BACK ACRE CIRCLE SUITE 290C
MOUNT AIRY MD
21711-7769
US

IV. Provider business mailing address

2702 BACK ACRE CIRCLE SUITE 290C
MOUNT AIRY MD
21711-7769
US

V. Phone/Fax

Practice location:
  • Phone: 301-703-5067
  • Fax: 301-703-5067
Mailing address:
  • Phone: 301-703-5067
  • Fax: 301-703-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JYOTHI RAO-MAHADEVIA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-703-5067