1538345046 NPI number — CHARM CITY HEALTHCARE, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538345046 NPI number — CHARM CITY HEALTHCARE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARM CITY HEALTHCARE, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538345046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 HICKORY KNOLL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-4745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-335-0008
Provider Business Mailing Address Fax Number:
410-682-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 EASTERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21221-7020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-687-8818
Provider Business Practice Location Address Fax Number:
410-682-3989
Provider Enumeration Date:
01/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KHETERPAL
Authorized Official First Name:
PANKAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-335-0008

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1026426040001 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 137523 . This is a "MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: DO6030 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1538345046 . This is a "BRAVO HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1538345046 . This is a "TRICARE NORTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538345046 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: N681 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 30044355001 . This is a "HEALTH NET FEDERAL SERVICES - TRICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 417399600 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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