Provider Demographics
NPI:1093073744
Name:COMMITTED TO CHANGE, PC
Entity Type:Organization
Organization Name:COMMITTED TO CHANGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-290-8800
Mailing Address - Street 1:8965 GUILFORD RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2384
Mailing Address - Country:US
Mailing Address - Phone:410-290-8800
Mailing Address - Fax:410-290-8860
Practice Address - Street 1:8965 GUILFORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2384
Practice Address - Country:US
Practice Address - Phone:410-290-8800
Practice Address - Fax:410-290-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056120261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4037251Medicaid