MEDICARE: COLUMBIA MEDICS INC

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	207R00000X	Internal Medicine Physician	D0073685	MD

General Provider Information

NPI Number	:	1861857484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA MEDICS INC

Provider Business Mailing Address
First Line	:	10615 OLD ELLICOTT CIR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2199
Country	:	US
Telephone Number	:	443-355-4680
Fax Number	:	208-723-5911

Provider Business Practice Location Address
First Line	:	10615 OLD ELLICOTT CIR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2199
Country	:	US
Telephone Number	:	443-355-4680
Fax Number	:	208-723-5911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SESHA S ADUSUMILLI
Credential	:	MD
Telephone Number	:	443-355-4680

Provider Enumeration Date	:	12/25/2015
Last Update Date	:	12/25/2015

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