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Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJIV DUA MD (MEDICAL DIRECTOR)
(410) 730-3399
Entity
Organization
Contact information
Practice address
15646 OLD COLUMBIA PIKE, BURTONSVILLE, MD 20866-1630
(410) 730-3399
(443) 478-4747
Mailing address
6230 OLD DOBBIN LN, COLUMBIA, MD 21045-5803
(410) 730-3399
(443) 478-4737
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
12/20/2023
Last updated
09/18/2024
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