Provider Demographics
NPI:1568680213
Name:ALLCARE OF MARYLAND, LLC
Entity type:Organization
Organization Name:ALLCARE OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-290-9990
Mailing Address - Street 1:6955 OAKLAND MILLS RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5849
Mailing Address - Country:US
Mailing Address - Phone:410-290-9990
Mailing Address - Fax:410-290-9996
Practice Address - Street 1:9396D BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2802
Practice Address - Country:US
Practice Address - Phone:410-480-1990
Practice Address - Fax:410-630-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG52637Medicare UPIN
MDF49289Medicare UPIN
MDK8690002OtherBCBS - DR.KUKRETI
MDK8690003OtherBCBS- DR.FUSELIER
MDG52637Medicare UPIN
MD1720157647OtherNPI - DR. EHSANI
MD1275507550Medicare ID - Type UnspecifiedNPI- DR.KUKRETI
MD1629092465Medicare ID - Type UnspecifiedNPI- DR.KIM
MDK8690001OtherBCBS- DR. KIM
MD1891872016Medicare ID - Type UnspecifiedNPI- DR. FUSELIER