Provider Demographics
NPI:1972976298
Name:ASKLEPIOS, LLC
Entity Type:Organization
Organization Name:ASKLEPIOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAITANYA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-521-4211
Mailing Address - Street 1:5400 OLD COURT RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5100
Mailing Address - Country:US
Mailing Address - Phone:410-521-4211
Mailing Address - Fax:410-521-0627
Practice Address - Street 1:5400 OLD COURT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5100
Practice Address - Country:US
Practice Address - Phone:410-521-4211
Practice Address - Fax:410-521-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD594321300Medicaid
MD7968Medicare PIN