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Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Parent organization
CENTENNIAL MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTENNIAL MEDICAL GROUP
Authorized official
DR. RAJIV DUA MD (MEDICAL DIRECTOR)
(410) 730-3399
Entity
Organization
Contact information
Practice address
1071 MD RT 3 N, GAMBRILLS, MD 21054-1784
(410) 721-2333
Mailing address
6230 OLD DOBBIN LN, COLUMBIA, MD 21045-5803
(410) 730-3399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
05/31/2022
Last updated
09/18/2024
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