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CENTENNIAL MEDICAL GROUP PA NPI 1134235039


NPI Information

NPI: 1134235039
Provider Name: CENTENNIAL MEDICAL GROUP, PA

Other Name: CENTENNIAL MEDICAL GROUP MULTI SPECIALTY

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 21D0976641

Address:
6250 OLD DOBBIN LN
COLUMBIA, MD
ZIP 21045
Phone: (410) 730-3399
Get Directions

CENTENNIAL MEDICAL GROUP, PA is a family medicine in Columbia, MD. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CENTENNIAL MEDICAL GROUP, PA NPI is 1134235039. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Centennial Medical Group Multi Specialty.

The provider's business location address is:

6250 OLD DOBBIN LN
COLUMBIA, MD
ZIP 21045-816
Phone: (410) 730-3399
Fax: (443) 478-4737

The provider's authorized official is Ria Young .
The authorized official title is Credentialing Manager and has the following contact phone number (410) 730-3399.

The CLIA number assigned to this NPI record is 21D0976641 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/22/2006 and was last updated on 4/3/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207KA0200XAllergy & ImmunologyAllergyNo
2207P00000XEmergency MedicineNo
3207Q00000XFamily MedicineYes
4207R00000XInternal MedicineNo
5207RA0201XInternal MedicineAllergy & ImmunologyNo
6208100000XPhysical Medicine & RehabilitationNo
72083X0100XPreventive MedicineOccupational MedicineNo
8208D00000XGeneral PracticeNo
9332900000XNon-Pharmacy Dispensing SiteNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R481OTHERMARYLANDBCBS
2470010400MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.