Provider Demographics
NPI:1750110946
Name:CHARM CITY OPIOID TREATMENT
Entity type:Organization
Organization Name:CHARM CITY OPIOID TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVESH
Authorized Official - Middle Name:DHRUVA
Authorized Official - Last Name:KANJARPANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-646-3279
Mailing Address - Street 1:6041 WINTER GRAIN PATH
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1224
Mailing Address - Country:US
Mailing Address - Phone:301-675-1296
Mailing Address - Fax:443-535-0773
Practice Address - Street 1:2220 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1928
Practice Address - Country:US
Practice Address - Phone:301-675-1296
Practice Address - Fax:443-535-0773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARM CITY MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-29
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone