# CENTENNIAL MEDICAL GROUP, PA

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

## Provider details

- **NPI number:** 1477338325
- **Legal business name:** CENTENNIAL MEDICAL GROUP, PA
- **Authorized official:** DR. RAJIV DUA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (410) 730-3399

## Contact information

- **Practice address:** 6742 DORSEY RD, ELKRIDGE, MD 21075-6205
- **Practice address phone:** (443) 698-8664
- **Practice address fax:** (443) 338-8860
- **Mailing address:** 8186 LARK BROWN RD, ELKRIDGE, MD 21075-6433
- **Mailing address phone:** (410) 730-3399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/29/2023
- **Last updated:** 09/18/2024