NPIMap

Organization Active NPI

Centennial Medical Group, PA

  • Family Medicine Physician
  • Burtonsville, MD
National Provider Identifier
1093584930
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
15646 Old Columbia Pike
Burtonsville, MD 20866-1630
Phone
(410) 730-3399
Fax
(443) 478-4747
NPI assigned
Dec 20, 2023
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rajiv Dua, MDNPI 1043326945
Title
Medical Director
Phone
(410) 730-3399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

15646 Old Columbia Pike
Burtonsville, MD 20866-1630

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Invalid Record8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

6230 Old Dobbin Ln
Columbia, MD 21045

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1093584930",
    "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",
            "fax_number": "443-478-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15646 OLD COLUMBIA PIKE",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661630",
            "telephone_number": "410-730-3399",
            "fax_number": "443-478-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-20",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burtonsville, 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.