Provider Demographics
NPI:1093068132
Name:COMMITTED TO CHANGE, P.C.
Entity Type:Organization
Organization Name:COMMITTED TO CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-580-1919
Mailing Address - Street 1:200 GLENN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2583
Mailing Address - Country:US
Mailing Address - Phone:240-580-1919
Mailing Address - Fax:240-362-7409
Practice Address - Street 1:200 GLENN ST STE 302
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2583
Practice Address - Country:US
Practice Address - Phone:240-580-1919
Practice Address - Fax:240-362-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1213251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD758603501Medicaid