Provider Demographics
NPI:1356643035
Name:ELLICOTT CITY PRIMARY CARE PHYSICIANS, PA
Entity type:Organization
Organization Name:ELLICOTT CITY PRIMARY CARE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:ANWAR
Authorized Official - Last Name:HASHMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-997-2770
Mailing Address - Street 1:10910 LITTLE PATUXENT PARKWAY
Mailing Address - Street 2:#200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-997-2770
Mailing Address - Fax:410-997-0066
Practice Address - Street 1:10910 LITTLE PATUXENT PARKWAY
Practice Address - Street 2:#200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-997-2770
Practice Address - Fax:410-997-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67217173000000X
MDD00670202080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442008000Medicaid
MD419513200Medicaid
MD415060102Medicaid
MD197407Medicare PIN
MD771507601166Medicare Oscar/Certification
MD740197Medicare UPIN
MD442008000Medicaid