# CENTENNIAL MEDICAL GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Centennial Medical Group Multi Specialty
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134235039
- **Authorized official:** DR. RAJIV DUA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (410) 730-3399

## Contact information

- **Practice address:** 6250 OLD DOBBIN LN, COLUMBIA, MD 21045-5816
- **Practice address phone:** (410) 730-3399
- **Practice address fax:** (443) 478-4737
- **Mailing address:** 6230 OLD DOBBIN LN STE 230, COLUMBIA, MD 21045-5884
- **Mailing address phone:** (410) 730-3399
- **Mailing address fax:** (443) 478-4737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KA0200X | Allergy Physician | — | NULL | — |
| 207KA0200X | Allergy Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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