Provider Demographics
NPI:1942689195
Name:LIVE LITE MD LLC
Entity Type:Organization
Organization Name:LIVE LITE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITU
Authorized Official - Middle Name:T
Authorized Official - Last Name:BHAMBHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-857-1416
Mailing Address - Street 1:100 WALTER WARD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER WARD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1284
Practice Address - Country:US
Practice Address - Phone:410-569-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty