Organization
CENTENNIAL MEDICAL GROUP, PA
Active
Other names
Centennial Medical Group Multi Specialty
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJIV DUA MD (MEDICAL DIRECTOR)
(410) 730-3399
Entity
Organization
Contact information
Practice address
6250 OLD DOBBIN LN, COLUMBIA, MD 21045-5816
(410) 730-3399
(443) 478-4737
Mailing address
6230 OLD DOBBIN LN STE 230, COLUMBIA, MD 21045-5884
(410) 730-3399
(443) 478-4737
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2083X0100X
Occupational Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470010400
—
MD
01
—
R481
BCBS
MD
Enumeration date
08/22/2006
Last updated
09/18/2024
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