Individual provider Active NPI

Raksha Mirchandani

  • Endodontics
  • Ellicott City, MD
National Provider Identifier
1245416890
Registry record updated Sep 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
13446 Issued in MD
Practice address
5072 Dorsey Hall Dr Ste 102
Ellicott City, MD 21042-7845
Phone
(410) 997-7668
Fax
(410) 992-7668
NPI assigned
Jan 14, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 13446 MD Primary

Addresses

Primary practice location

5072 Dorsey Hall Dr Ste 102
Ellicott City, MD 21042-7845

Mailing address

5072 Dorsey Hall Dr Ste 102
Ellicott City, MD 21042-7845
Phone (410) 997-7668

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041210000869 MD Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 6800853813 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins University CurrentSince Feb 3, 2011 Accepting new patients
Johns Hopkins University Current Accepting new patients
Johns Hopkins University CurrentSince Feb 3, 2011 Accepting new patients

Locations

600 N Wolfe St
#266
Baltimore, MD 21287
Phone (410) 502-4340

600 N Wolfe St
Baltimore, MD 21287

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411689600000",
    "number": "1245416890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5072 DORSEY HALL DR STE 102",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427845",
            "telephone_number": "410-997-7668",
            "fax_number": "410-992-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5072 DORSEY HALL DR STE 102",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427845",
            "telephone_number": "410-997-7668",
            "fax_number": "410-992-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRCHANDANI",
        "first_name": "RAKSHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-14",
        "last_updated": "2014-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MD",
            "license": "13446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.