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General NPI Number Information
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NPI Number | 1134235039
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Entity Type | Organization
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Legal Business Name | CENTENNIAL MEDICAL GROUP, PA
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 6250 OLD DOBBIN LN
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City | COLUMBIA
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State | MD
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Zip | 21045-5816
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Country | US
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Telephone | 410-730-3399
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Fax | 443-478-4737
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Provider Business Mailing Address
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Address Line | 6230 OLD DOBBIN LN STE 230
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City | COLUMBIA
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State | MD
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Zip | 21045-5884
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Country | US
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Telephone | 410-730-3399
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Fax | 443-478-4737
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAJIV DUA
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Credential | MD
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Telephone | 410-730-3399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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