Provider Demographics
NPI:1104505312
Name:FAMILY INTERNAL MEDICINE PA INC
Entity type:Organization
Organization Name:FAMILY INTERNAL MEDICINE PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGABHAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-407-6107
Mailing Address - Street 1:503 SHAW ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-4151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-1534
Practice Address - Country:US
Practice Address - Phone:717-373-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty