Provider Demographics
NPI:1821356973
Name:COMMITTED TO CHANGE PC
Entity Type:Organization
Organization Name:COMMITTED TO CHANGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-580-1919
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:M304
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:240-580-1919
Mailing Address - Fax:443-276-6712
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:M304
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:240-580-1919
Practice Address - Fax:443-276-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058483261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403435003Medicaid