Provider Demographics
NPI:1417004250
Name:CENTRAL MARYLAND PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL MARYLAND PRIMARY CARE ASSOCIATES
Other - Org Name:CENTRAL MARYLAND PRIMARY CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SABAPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-391-8733
Mailing Address - Street 1:201 BACK RIVER NECK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3949
Mailing Address - Country:US
Mailing Address - Phone:410-391-8733
Mailing Address - Fax:410-391-9630
Practice Address - Street 1:201 BACK RIVER NECK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3949
Practice Address - Country:US
Practice Address - Phone:410-391-8733
Practice Address - Fax:410-391-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD368161100Medicaid
MD402778700Medicaid
MDKZ87CEOtherBLUE CROSS GROUP
MDE54900OtherFEDERAL BLUE CROSS
MD35180307OtherCAREFIRST BS DR SABPATHI
MD934675900Medicaid
MDE549004OtherFED BC BS DR SABAPATHI
MD621313OtherCAREFIRST BC DR KHETERPAL
MDE5490010OtherFED BC BS DR KHETERPAL
MDP00061247Medicare ID - Type UnspecifiedRAIL ROAD MC DR KHETERPAL
MD112LMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
MDH90303Medicare UPIN
MD368161100Medicaid
MDCD 6145Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP
MD112LG725Medicare ID - Type UnspecifiedPANKAJ KHETRPAL
MD110144189Medicare ID - Type UnspecifiedRAILROAD MC DR SABAPATHI
MD621313OtherCAREFIRST BC DR KHETERPAL