Provider Demographics
NPI:1679673701
Name:CENTRAL MARYLAND NEPHROLOGY, LLC
Entity Type:Organization
Organization Name:CENTRAL MARYLAND NEPHROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:IPAKCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-345-0605
Mailing Address - Street 1:7331 HANOVER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3621
Mailing Address - Country:US
Mailing Address - Phone:301-345-0605
Mailing Address - Fax:301-345-0606
Practice Address - Street 1:7331 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3621
Practice Address - Country:US
Practice Address - Phone:301-345-0605
Practice Address - Fax:301-345-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00573Medicare PIN