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General NPI Number Information
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NPI Number | 1699572396
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Entity Type | Organization
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Legal Business Name | CENTENNIAL MEDICAL GROUP
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 10981 JOHNS HOPKINS RD
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City | LAUREL
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State | MD
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Zip | 20723-6002
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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 | CREDENTIALING MANAGER
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Name | RIA YOUNG
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Credential |
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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 | 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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