MEDICARE: COMPREHENSIVE PRIMARY CARE AND ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	363LF0000X	Family Nurse Practitioner
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1700719564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PRIMARY CARE AND ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	15245 SHADY GROVE RD STE 340
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-7201
Country	:	US
Telephone Number	:	301-869-9776
Fax Number	:	301-417-4947

Provider Business Practice Location Address
First Line	:	9398 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2802
Country	:	US
Telephone Number	:	301-869-9776
Fax Number	:	301-417-4947

Authorized Official
Title or Position	:	CO-CHIEF EXECUTIVE OFFICER
Name	:	KONSTANTIN A KHLUDENEV
Credential	:	MD
Telephone Number	:	301-869-9776

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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