NPIMap

Organization Active NPI

Centennial Medical Group, PA

  • Family Medicine Physician
  • Gambrills, MD
National Provider Identifier
1033858832
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTENNIAL MEDICAL GROUP, PA
Practice address
1071 MD RT 3 N
Gambrills, MD 21054-1784
Phone
(410) 721-2333
NPI assigned
May 31, 2022
Organization subpart
Yes
Parent organization
CENTENNIAL MEDICAL GROUPAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Dr. Rajiv Dua, MD
Title
Medical Director
Phone
(410) 730-3399

Corporate family (same tax ID) 7

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Invalid Record (8 organizations share this tax ID)
Part of
Invalid Record

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

NPPES NPI Registry

Primary practice location

1071 MD RT 3 N
Gambrills, MD 21054-1784

Mailing address

6230 Old Dobbin LN
Columbia, MD 21045-5803
Phone (410) 730-3399

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 18, 2024.

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1033858832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6230 OLD DOBBIN LN",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455803",
            "telephone_number": "410-730-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 MD RT 3 N",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541784",
            "telephone_number": "410-721-2333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTENNIAL MEDICAL GROUP",
        "enumeration_date": "2022-05-31",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "DUA",
        "authorized_official_first_name": "RAJIV",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "410-730-3399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.