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General NPI Number Information
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NPI Number | 1417815127
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PRIMARY CARE AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 3716 CRAIN HWY
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City | WALDORF
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State | MD
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Zip | 20603-4890
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Country | US
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Telephone | 301-869-9776
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Fax | 301-417-4947
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Provider Business Mailing Address
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Address Line | 15245 SHADY GROVE RD STE 340
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City | ROCKVILLE
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State | MD
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Zip | 20850-7201
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Country | US
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Telephone | 301-869-9776
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Fax | 301-417-4947
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Authorized Official
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Title or Position | CO-CHIEF EXECUTIVE OFFICER
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Name | KONSTANTIN A KHLUDENEV
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Credential | MD
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Telephone | 301-869-9776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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