# CENTENNIAL MEDICAL GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTENNIAL MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1245953009
- **Legal business name:** CENTENNIAL MEDICAL GROUP
- **Authorized official:** DR. RAJIV DUA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (410) 730-3399

## Contact information

- **Practice address:** 10120 BALTIMORE NATIONAL PIKE, ELLICOTT CITY, MD 21042-3614
- **Practice address phone:** (410) 694-7999
- **Mailing address:** 6230 OLD DOBBIN LN, COLUMBIA, MD 21045-5803
- **Mailing address phone:** (410) 730-3399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 09/26/2022
- **Last updated:** 09/18/2024