Healthcare Provider Details

I. General information

NPI: 1952230955
Provider Name (Legal Business Name): MGHCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12413 RIVERS EDGE DR
POTOMAC MD
20854-1071
US

IV. Provider business mailing address

12413 RIVERS EDGE DR
POTOMAC MD
20854-1071
US

V. Phone/Fax

Practice location:
  • Phone: 203-836-0534
  • Fax:
Mailing address:
  • Phone: 203-836-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANSI TANEJA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 203-836-0534