Provider Demographics
NPI:1801054630
Name:THE MEDICAL CLINIC
Entity type:Organization
Organization Name:THE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHANPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-460-1073
Mailing Address - Street 1:2002 MEDICAL PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7904
Mailing Address - Country:US
Mailing Address - Phone:301-441-2269
Mailing Address - Fax:301-345-1768
Practice Address - Street 1:7500 HANOVER PKWY STE 205
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2009
Practice Address - Country:US
Practice Address - Phone:301-441-2269
Practice Address - Fax:301-345-1768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053733208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty