Maryland Primary Care Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MARYLAND PRIMARY CARE CLINIC LLC

Practice address

8114 Sandpiper Cir Ste 202
Baltimore, MD 21236-5902

Phone

(352) 745-4398

NPI assigned

Mar 19, 2024

Last updated

Mar 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lata Pradhan, NP

Title

NP

Phone

(352) 745-4398

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 2

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.

• Lata Shrestha Pradhan, APRN

  • Nurse Practitioner
  • Glen Burnie, MD
  • NPI 1497498927
  Medicare reassignment Care Compare group NPD
• Dilli Ram Poudel, MD

  • Hospitalist Physician
  • York, PA
  • NPI 1568754786

  MD

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1417717539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8114 SANDPIPER CIR STE 202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365902",
            "telephone_number": "352-745-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8114 SANDPIPER CIR STE 202",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212365902",
            "telephone_number": "352-745-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYLAND PRIMARY CARE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "PRADHAN",
        "authorized_official_first_name": "LATA",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "352-745-4398",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryland Physical Therapy Group, Inc. Ta Mid-Towne Medical Group, Inc. (Mid-Towne Medical Group, Inc.)
• Maryland Physicians Associates
• Maryland Podiatry PA
• Maryland Podiatry PA
• Maryland Podiatry Services, Inc.
• Maryland Priority Caregivers LLC
• Maryland Prosthodontic Associates, PC
• Maryland Proton Treatment Center, LLC (Maryland Proton Treatment Center)
• Maryland Provo-I Medical Services, PC
• Maryland Psychiatric Associates LLC

• Family Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.