Provider Demographics
NPI:1669618898
Name:THE MEDICAL CLINIC, PA
Entity type:Organization
Organization Name:THE MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHANPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-460-1073
Mailing Address - Street 1:5880, 49TH STREET N
Mailing Address - Street 2:SUITE 101 N
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2150
Mailing Address - Country:US
Mailing Address - Phone:727-528-0815
Mailing Address - Fax:727-528-1724
Practice Address - Street 1:7500 HANOVER PARKWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-441-2269
Practice Address - Fax:301-441-2009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty