Healthcare Provider Details

I. General information

NPI: 1467328864
Provider Name (Legal Business Name): PRIMECARE INTERNAL MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 BALTIMORE BLVD
FINKSBURG MD
21048-1301
US

IV. Provider business mailing address

2059 BALTIMORE BLVD
FINKSBURG MD
21048-1301
US

V. Phone/Fax

Practice location:
  • Phone: 443-850-2323
  • Fax: 410-941-2766
Mailing address:
  • Phone: 443-850-2323
  • Fax: 410-941-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BERNARD A MBEBOH
Title or Position: MD
Credential: MD
Phone: 443-850-2323