Provider Demographics
NPI:1740387257
Name:ANNE ARUNDEL DIGESTIVE CENTER
Entity Type:Organization
Organization Name:ANNE ARUNDEL DIGESTIVE CENTER
Other - Org Name:GLEN BURNIE ENDOSCOPY, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIF
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANEJWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-766-1012
Mailing Address - Street 1:8028 RITCHIE HIGHWAY
Mailing Address - Street 2:SUITE 142
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-766-1012
Mailing Address - Fax:410-766-2415
Practice Address - Street 1:8028 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE 142
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-766-1012
Practice Address - Fax:410-766-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1208261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1012002-00Medicaid
MD21C0001208Medicare ID - Type Unspecified