Provider Demographics
NPI:1114321767
Name:CHARM CITY PRIMARY CARE, LLC
Entity type:Organization
Organization Name:CHARM CITY PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER (CMO)
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVESH
Authorized Official - Middle Name:DHRUVA
Authorized Official - Last Name:KANJARPANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH FACPM FACOEM
Authorized Official - Phone:301-675-1296
Mailing Address - Street 1:6041 WINTER GRAIN PATH
Mailing Address - Street 2:STE #1F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1224
Mailing Address - Country:US
Mailing Address - Phone:301-675-1296
Mailing Address - Fax:443-535-0773
Practice Address - Street 1:2220 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1928
Practice Address - Country:US
Practice Address - Phone:301-675-1296
Practice Address - Fax:443-535-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00400762083P0500X
261QC1500X, 261QH0100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service