Provider Demographics
NPI:1881664290
Name:ANNE ARUNDEL RHEUMATOLOGY, LLC
Entity Type:Organization
Organization Name:ANNE ARUNDEL RHEUMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHU
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-292-4872
Mailing Address - Street 1:PO BOX 37168
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3168
Mailing Address - Country:US
Mailing Address - Phone:443-292-4872
Mailing Address - Fax:443-292-4892
Practice Address - Street 1:1655 CROFTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1342
Practice Address - Country:US
Practice Address - Phone:443-292-4872
Practice Address - Fax:443-292-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
MDD0060213207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD0563OtherRR MEDICARE
MD409668100Medicaid
H21086Medicare UPIN
145PMedicare PIN
MD409668100Medicaid