MEDICARE: MGHCC LLC

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	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1952230955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MGHCC LLC

Provider Business Mailing Address
First Line	:	12413 RIVERS EDGE DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-1071
Country	:	US
Telephone Number	:	203-836-0534
Fax Number	:

Provider Business Practice Location Address
First Line	:	12413 RIVERS EDGE DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-1071
Country	:	US
Telephone Number	:	203-836-0534
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MANSI TANEJA
Credential	:	MD
Telephone Number	:	203-836-0534

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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