| |
10816 Hickory Ridge Rd Columbia MD 21044-3622 | |
(410) 997-7677 | |
(410) 997-1636 |
Full Name | |
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Speciality | Internal Medicine |
Location | 10816 Hickory Ridge Rd, Columbia, Maryland |
Authorized Official Name and Position | Imran H Chowdhury (PARTNER) |
Authorized Official Contact | 4109977677 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
9784 Old Annapolis Rd Ellicott City MD 21042-6327 Ph: (410) 997-1336 | 10816 Hickory Ridge Rd Columbia MD 21044-3622 Ph: (410) 997-7677 |
NPI Number | 1699728089 |
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Provider Enumeration Date | 05/18/2006 |
Last Update Date | 07/25/2024 |
Medicare PECOS PAC ID | 3274554126 |
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Medicare Enrollment ID | O20051207000901 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699728089 | NPI | - | NPPES |
N151 | Other | MD | BLUE CROSS FEDERAL |
1142274 | Other | MD | AETNA HMO |
164694407A | Medicaid | GA | |
36579100 | Medicaid | DC | |
606751 | Other | MD | EVERCARE |
7416227 | Other | MD | AETNA NON HMO |
409510300 | Medicaid | MD | |
494C | Other | MD | BLUE CROSS OF MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
Provider Name | Khodadad Modjtabai |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1578567913 PECOS PAC ID: 0244210474 Enrollment ID: I20040720001192 |
Provider Name | Imran H Chowdhury |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1396747549 PECOS PAC ID: 2466432695 Enrollment ID: I20040720001216 |
Provider Name | Imelda T Russell |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528163540 PECOS PAC ID: 3678572492 Enrollment ID: I20061205000458 |
Provider Name | May Lynn Samonte |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730509803 PECOS PAC ID: 7113142498 Enrollment ID: I20140630000222 |
Provider Name | Khalilah Jefferson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1609207778 PECOS PAC ID: 9234356692 Enrollment ID: I20140807001479 |
Provider Name | Ajibola K Ibironke |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073914685 PECOS PAC ID: 8729330964 Enrollment ID: I20181120003168 |
Provider Name | Binnur Genc |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518311513 PECOS PAC ID: 2062790991 Enrollment ID: I20190204000289 |
Provider Name | Christiane Happi |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1386004133 PECOS PAC ID: 3173821774 Enrollment ID: I20190214000823 |
Provider Name | Chidi R Nwachukwu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578031977 PECOS PAC ID: 4587907647 Enrollment ID: I20190514000848 |
Provider Name | Janeika A Barnes |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740751924 PECOS PAC ID: 8224366752 Enrollment ID: I20200409000377 |
Provider Name | Zeena A Daniel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1083380414 PECOS PAC ID: 7315335460 Enrollment ID: I20211022001486 |
Provider Name | Gladys Happi |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548598519 PECOS PAC ID: 9436537701 Enrollment ID: I20220528000207 |
Provider Name | Melda Fineran |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1326760141 PECOS PAC ID: 1557719333 Enrollment ID: I20231205001475 |
Provider Name | Meliza A Sotelo |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588092423 PECOS PAC ID: 1254641210 Enrollment ID: I20240131000605 |
Provider Name | Shirley Gomez-cheng |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063255222 PECOS PAC ID: 8022559889 Enrollment ID: I20240919002510 |
Ethos Health Maryland 3 Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10840 Little Patuxent Pkwy, Columbia, MD 21044 Phone: 352-732-5590 Fax: 352-732-0292 | |
Lorien Dialysis, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6334 Cedar Ln, Columbia, MD 21044 Phone: 410-750-7500 | |
Premier Medical Group Of Maryland Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10705 Charter Dr Ste 420, Columbia, MD 21044 Phone: 410-709-7432 | |
University Of Maryland Physicians, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5890 Waterloo Rd, Columbia, MD 21045 Phone: 410-667-2142 Fax: 410-799-9097 | |