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Organization
LIFE LINE CORPORATION -4 LLC
Active
Organization
LIFE LINE CORPORATION -4 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMAL GORDHANBHAI BANGORIA MD (OWNER)
(410) 848-2566
Entity
Organization
Contact information
Practice address
2111 HANOVER PIKE, HAMPSTEAD, MD 21074-1319
(443) 255-3951
Mailing address
1798 ODEN WAY, ELDERSBURG, MD 21784-7095
(443) 255-3951
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/02/2025
Last updated
05/02/2025
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