Provider Demographics
NPI:1538345046
Name:CHARM CITY HEALTHCARE, L.L.C.
Entity type:Organization
Organization Name:CHARM CITY HEALTHCARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHETERPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-335-0008
Mailing Address - Street 1:20 HICKORY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4745
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-682-3989
Practice Address - Street 1:120 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-7020
Practice Address - Country:US
Practice Address - Phone:410-687-8818
Practice Address - Fax:410-682-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026426040001OtherMEDICAL ASSISTANCE
MD137523OtherMEDICARE
GADO6030OtherRAILROAD MEDICARE
MD1538345046OtherBRAVO HEALTH
1538345046OtherTRICARE NORTH REGION
VA1538345046OtherMEDICAL ASSISTANCE
DCN681OtherCAREFIRST
SC30044355001OtherHEALTH NET FEDERAL SERVICES - TRICARE
MD417399600OtherMEDICAL ASSISTANCE