| Columbia Patient Care Associates, Llc | |
|
11085 Little Patuxent Pkwy Medical Arts Bldg - Ste L001 Columbia MD 21044-2983 | |
| (410) 884-4939 | |
| (410) 884-4991 |
| Full Name | Columbia Patient Care Associates, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11085 Little Patuxent Pkwy, Columbia, Maryland |
| Authorized Official Name and Position | Sirilatha Kanumuru (CO-OWNER) |
| Authorized Official Contact | 4108844939 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Patient Care Associates, Llc Po Box 1121 Columbia MD 21044-0121 Ph: (410) 884-4939 | Columbia Patient Care Associates, Llc 11085 Little Patuxent Pkwy Medical Arts Bldg - Ste L001 Columbia MD 21044-2983 Ph: (410) 884-4939 |
| NPI Number | 1568730414 |
|---|---|
| Provider Enumeration Date | 12/07/2011 |
| Last Update Date | 12/07/2011 |
| Medicare PECOS PAC ID | 2860659398 |
|---|---|
| Medicare Enrollment ID | O20120210000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568730414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Srilatha Kanumuru |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417985854 PECOS PAC ID: 1052317823 Enrollment ID: I20061201000051 |
| Provider Name | Mythily Vancha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548292022 PECOS PAC ID: 6608875927 Enrollment ID: I20090421000019 |
| Provider Name | Shahab Z Bavani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326061672 PECOS PAC ID: 4082611520 Enrollment ID: I20090504000480 |
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