Individual provider Active NPI

Lilit Vardanyan, PA

  • Physician Assistant
  • Odenton, MD
National Provider Identifier
1427485515
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0005152 Issued in MD
Practice address
1110 Annapolis Rd
Odenton, MD 21113-1602
Phone
(443) 351-3917
NPI assigned
Oct 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0005152 MD Primary

Addresses

Primary practice location

1110 Annapolis Rd
Odenton, MD 21113-1602

Mailing address

PO Box 759047
Baltimore, MD 21275-9047
Phone (804) 968-5700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140313001520 MD Practitioner - Physician Assistant 3274763248 Reassigns benefits to 1 organization
I20140327000569 DC Practitioner - Physician Assistant 3274763248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Patient First Maryland Medical Group PLLCGroup PAC ID 4385538735, shared by 26 NPIs, 258 clinicians

Practice addresses (Care Compare)

10210 Reisterstown Rd
Owings Mills, MD 21117-3606
Phone (410) 902-6776

10424 Baltimore Ave
Beltsville, MD 20705-2321
Phone (240) 542-5987

13671 Georgia Ave
Aspen Hill, MD 20906-5214
Phone (240) 514-0000

21044 Frederick Rd
Germantown, MD 20876-4132
Phone (240) 238-5432

6333 Baltimore Nat Pike
Catonsville, MD 21228-3910
Phone (443) 514-1361

726 Rockville Pike
Rockville, MD 20852-1133
Phone (240) 238-0411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0005152MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Patient First Maryland Medical Group PLLC CurrentSince Nov 26, 2013 Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Nov 26, 2013 Accepting new patients
Patient First Maryland Medical Group PLLC CurrentSince Dec 30, 2013 Accepting new patients
Patient First Maryland Medical Group, PLLC Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1110 Annapolis Rd
Odenton, MD 21113
Phone (443) 351-3917

10210 Reisterstown Rd
Owings Mills, MD 21117
Phone (410) 902-6776

10210 Reisterstown Rd
#12302
Owings Mills, MD 21117
Phone (410) 902-6776

726 Rockville Pike
Rockville, MD 20852
Phone (240) 238-0411

2855 Crain Hwy
Waldorf, MD 20601
Phone (240) 427-1926

5000 Cox Rd
Glen Allen, VA 23060
Phone (804) 822-4355

Organizations & group practices 5

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": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1427485515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759047",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212759047",
            "telephone_number": "804-968-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ANNAPOLIS RD",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131602",
            "telephone_number": "443-351-3917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARDANYAN",
        "first_name": "LILIT",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-03",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0005152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odenton, MD

Sources for this page

Verify at the official NPI Registry.