Provider Demographics
NPI:1265812549
Name:COMMITTED TO CHANGE,P.C.
Entity type:Organization
Organization Name:COMMITTED TO CHANGE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
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:410-990-1811
Mailing Address - Street 1:420 CHINQUAPIN ROUND RD STE 2-I2K2L
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4006
Mailing Address - Country:US
Mailing Address - Phone:410-990-1811
Mailing Address - Fax:410-990-0081
Practice Address - Street 1:420 CHINQUAPIN ROUND RD
Practice Address - Street 2:SUITE 2-I
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4006
Practice Address - Country:US
Practice Address - Phone:410-990-1811
Practice Address - Fax:410-990-0081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMITTED TO CHANGE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-02
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1559261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7586035-01Medicaid