Provider Demographics
NPI:1013004274
Name:PHYSICIANS MEDICAL PRACTICE PA
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KANWALJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-352-6126
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-2086
Mailing Address - Country:US
Mailing Address - Phone:301-352-6126
Mailing Address - Fax:
Practice Address - Street 1:3231 SUPERIOR LN
Practice Address - Street 2:A-8
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1923
Practice Address - Country:US
Practice Address - Phone:301-352-6126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00578472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02029Medicare ID - Type Unspecified
DCG01858Medicare ID - Type Unspecified
MD094NMedicare ID - Type Unspecified