Provider Demographics
NPI:1063456549
Name:MEDSTAR PHYSICIAN PARTNERS
Entity type:Organization
Organization Name:MEDSTAR PHYSICIAN PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDIACL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RABELLO FREIRE
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-686-9019
Mailing Address - Street 1:107 BEACON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3504
Mailing Address - Country:US
Mailing Address - Phone:410-686-9019
Mailing Address - Fax:410-687-1975
Practice Address - Street 1:107 BEACON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3504
Practice Address - Country:US
Practice Address - Phone:410-686-9019
Practice Address - Fax:410-687-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG57857Medicare UPIN
MD089L405VMedicare ID - Type Unspecified