Healthcare Provider Details

I. General information

NPI: 1851492276
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 9TH ST
FREDERICK MD
21701-4541
US

IV. Provider business mailing address

300 W 9TH ST
FREDERICK MD
21701-4541
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-8119
  • Fax: 301-696-0985
Mailing address:
  • Phone: 301-662-8119
  • Fax: 301-696-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERT AUSTIN PEARRE JR.
Title or Position: CHAIRMAN OF THE BOARD
Credential: MD
Phone: 301-662-8119