Provider Demographics
NPI:1568730414
Name:COLUMBIA PATIENT CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COLUMBIA PATIENT CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRILATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANUMURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-884-4939
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0121
Mailing Address - Country:US
Mailing Address - Phone:410-884-4939
Mailing Address - Fax:410-884-4991
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:MEDICAL ARTS BLDG - STE L001
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-884-4939
Practice Address - Fax:410-884-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty