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General NPI Number Information
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NPI Number | 1669618898
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Entity Type | Organization
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Legal Business Name | THE MEDICAL CLINIC, PA
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 7500 HANOVER PARKWAY SUITE 203
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City | GREENBELT
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State | MD
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Zip | 20770
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Country | US
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Telephone | 301-441-2269
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Fax | 301-441-2009
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Provider Business Mailing Address
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Address Line | 5880, 49TH STREET N SUITE 101 N
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City | SEMINOLE
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State | FL
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Zip | 33709-2150
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Country | US
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Telephone | 727-528-0815
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Fax | 727-528-1724
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANJIV LAKHANPAL
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Credential | MD
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Telephone | 240-460-1073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0053733
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License Number State | MD
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