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NPI Code Detail

MEDICARE: RIVERSIDE PRIMARY CARE ASSOCIATES LLC

MEDICARE: RIVERSIDE PRIMARY CARE ASSOCIATES 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
1207Q00000XFamily Medicine Physician
2208000000XPediatrics Physician
3207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962456962
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE PRIMARY CARE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 6510 KENILWORTH AVE
Second Line : SUITE 1400
City : RIVERDALE
State : MD
Zip : 20737-1339
Country : US
Telephone Number : 301-927-2683
Fax Number : 301-779-8243
Provider Business Practice Location Address
First Line : 6400 MARLBORO PIKE
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-2841
Country : US
Telephone Number : 301-736-7000
Fax Number : 301-736-6916
Authorized Official
Title or Position : PRESIDENT
Name : MADHU MOHAN KATIKINENI
Credential : M.D.
Telephone Number : 301-927-7750
Provider Enumeration Date : 05/22/2006
Last Update Date : 03/05/2015

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Directions to “RIVERSIDE PRIMARY CARE ASSOCIATES LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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