# CENTENNIAL MEDICAL GROUP, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336918275
- **Authorized official:** DR. RAJIV DUA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (410) 730-3399

## Contact information

- **Practice address:** 6339 TEN OAKS RD STE 100, CLARKSVILLE, MD 21029-1141
- **Practice address phone:** (410) 730-3399
- **Practice address fax:** (443) 478-4747
- **Mailing address:** 6230 OLD DOBBIN LN STE 230, COLUMBIA, MD 21045-5884
- **Mailing address phone:** (410) 730-3399
- **Mailing address fax:** (443) 478-4747

## 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:** 12/20/2023
- **Last updated:** 09/18/2024