Provider Demographics
NPI:1134120793
Name:DHAWAN, RITA KRISHAN (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KRISHAN
Last Name:DHAWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9055 CHEVROLET DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-461-8781
Mailing Address - Fax:410-461-8781
Practice Address - Street 1:8516 TIMBER VALLEY CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6065
Practice Address - Country:US
Practice Address - Phone:410-461-8781
Practice Address - Fax:410-461-8781
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0062534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407040200Medicaid
MD644915-01OtherCAREFIRST MD RENDERING
MD102007OtherJHHC PROVIDER NUMBER
MD2134393OtherMAMSI SPECIALIST
MD2511577OtherUHC PROVIDER NUMBER
MD8268449OtherCIGNA PIN
MD7278664OtherAETNA FEE FOR SERVICE
MDD0062534OtherMHIP PROVIDER ID
MD7605-0072OtherCAREFIRST BLUECHOICE
MD3769093OtherAETNA CAPITATED
MD8134393OtherMAMSI PRIMARY CARE
MDP16711OtherCAREFIRST MPOS