Provider Demographics
NPI:1104961150
Name:METROPOLITAN INTERNAL MEDICINE ASSOCIATES PA
Entity type:Organization
Organization Name:METROPOLITAN INTERNAL MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-897-5522
Mailing Address - Street 1:5616 SHIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3532
Mailing Address - Country:US
Mailing Address - Phone:301-897-5522
Mailing Address - Fax:301-897-2599
Practice Address - Street 1:5616 SHIELDS DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-3532
Practice Address - Country:US
Practice Address - Phone:301-897-5522
Practice Address - Fax:301-897-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053269207R00000X
MDD50220207R00000X
MDD0056136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400252100Medicaid
DCG0948Medicare PIN