Provider Demographics
NPI:1538138185
Name:MARYLAND NEPHROLOGY CLINIC LLC
Entity Type:Organization
Organization Name:MARYLAND NEPHROLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KULWANT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FRCP,FACP,FASN
Authorized Official - Phone:410-418-8740
Mailing Address - Street 1:4310 ENGLISH MORNING LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6790
Mailing Address - Country:US
Mailing Address - Phone:410-418-8740
Mailing Address - Fax:410-418-8740
Practice Address - Street 1:1940 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2245
Practice Address - Country:US
Practice Address - Phone:410-362-3331
Practice Address - Fax:410-362-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059917207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD363PMedicare PIN
MDE51974Medicare UPIN