NPIMap

Individual provider Active NPI

Mohammed G Kiddugavu, MD

  • Internal Medicine Physician
  • Randallstown, MD
National Provider Identifier
1952446601
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0070832 Issued in MD
Practice address
5415 Old Court Rd 101
Randallstown, MD 21133-5172
Phone
(410) 719-0020
Fax
(410) 744-6755
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0070832 MD Primary
Infectious Disease Physician 207RI0200X D0070832 MD

Addresses

Primary practice location

5415 Old Court Rd 101
Randallstown, MD 21133-5172

Mailing address

PO Box 4784
Baltimore, MD 21211-0784
Phone (410) 922-2650

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110112000152 MD Practitioner - Internal MedicinePractitioner - Infectious Disease 3678762382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5415 Old Court Rd
Suite 101
Randallstown, MD 21133-5172
Phone (410) 922-2650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ellicott City Health LLC CurrentSince Feb 23, 2026 Accepting new patients
Pikesville Health Services LLC CurrentSince Jan 1, 2017 Accepting new patients
Winchester Health LLC CurrentSince Dec 19, 2019 Accepting new patients
Orleans Health LLC CurrentSince Sep 19, 2022 Accepting new patients
Mukta Medical Inc Infectious Disease CurrentSince Oct 21, 2015 Accepting new patients
Sandtown Winchester Nursing Home, LLC Past Accepting new patients
6116 Belair Road Opco LLC Past Accepting new patients
Post-Acute Care Center Opco LLC Past Accepting new patients

Locations

1217 W Fayette St
Baltimore, MD 21223
Phone (410) 727-3947

5415 Old Court Rd
Randallstown, MD 21133
Phone (410) 601-1958

5415 Old Court Rd
Ste 101
Randallstown, MD 21133
Phone (410) 308-7855

Interoperability endpoints

  • Direct secure messaging: mkiddugavu232382@direct.umm.edu

Organizations & group practices 8

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1952446601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4784",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212110784",
            "telephone_number": "410-922-2650",
            "fax_number": "410-922-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 OLD COURT RD 101",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335172",
            "telephone_number": "410-719-0020",
            "fax_number": "410-744-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDUGAVU",
        "first_name": "MOHAMMED",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0070832",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MD",
            "license": "D0070832",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randallstown, MD

Sources for this page

Verify at the official NPI Registry.