Healthcare Provider Details

I. General information

NPI: 1831492586
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY CARE AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD STE 150
ROCKVILLE MD
20850-7210
US

IV. Provider business mailing address

15245 SHADY GROVE RD STE 340
ROCKVILLE MD
20850-7201
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-9776
  • Fax: 301-216-2592
Mailing address:
  • Phone: 301-869-9776
  • Fax: 301-417-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR129771
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD021152
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0046438
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0059013
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 10
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL
# 11
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KONSTANTIN KHLUDENEV
Title or Position: PARTNER
Credential: M.D.
Phone: 301-869-9776