Healthcare Provider Details

I. General information

NPI: 1417815127
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY CARE AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 CRAIN HWY
WALDORF MD
20603-4890
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: 301-417-4947
Mailing address:
  • Phone: 301-869-9776
  • Fax: 301-417-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KONSTANTIN A KHLUDENEV
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 301-869-9776