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Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Other names
Centennial Medical Group Multi Specialty
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJIV DUA MD (MEDICAL DIRECTOR)
(410) 730-3399
Entity
Organization
Contact information
Practice address
6250 OLD DOBBIN LN, COLUMBIA, MD 21045-5816
(410) 730-3399
(443) 478-4737
Mailing address
6230 OLD DOBBIN LN STE 230, COLUMBIA, MD 21045-5884
(410) 730-3399
(443) 478-4737
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
NULL
207KA0200X
Allergy Physician
—
—
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
—
NULL
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2083X0100X
Occupational Medicine Physician
—
NULL
2083X0100X
Occupational Medicine Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
NULL
Other
Enumeration date
08/22/2006
Last updated
09/18/2024
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