MEDICARE: RITA KRISHAN DHAWAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0062534	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	644915-01	OTHER	MD	CAREFIRST MD RENDERING
3	102007	OTHER	MD	JHHC PROVIDER NUMBER
4	2134393	OTHER	MD	MAMSI SPECIALIST
5	2511577	OTHER	MD	UHC PROVIDER NUMBER
6	8268449	OTHER	MD	CIGNA PIN
7	7278664	OTHER	MD	AETNA FEE FOR SERVICE
8	D0062534	OTHER	MD	MHIP PROVIDER ID
9	7605-0072	OTHER	MD	CAREFIRST BLUECHOICE
10	3769093	OTHER	MD	AETNA CAPITATED
11	8134393	OTHER	MD	MAMSI PRIMARY CARE
12	P16711	OTHER	MD	CAREFIRST MPOS

General Provider Information

NPI Number	:	1134120793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA KRISHAN DHAWAN MD

Provider Business Mailing Address
First Line	:	9055 CHEVROLET DRIVE
Second Line	:	SUITE 103
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	410-461-8781
Fax Number	:	410-461-8781

Provider Business Practice Location Address
First Line	:	8516 TIMBER VALLEY CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6065
Country	:	US
Telephone Number	:	410-461-8781
Fax Number	:	410-461-8781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	04/18/2018

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