Provider Demographics
NPI:1306805767
Name:INTERNAL MEDICINE ASSOCIATES, PA
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-774-2195
Mailing Address - Street 1:1139 CARTHAGE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4111
Mailing Address - Country:US
Mailing Address - Phone:919-774-2195
Mailing Address - Fax:919-776-8131
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4111
Practice Address - Country:US
Practice Address - Phone:919-774-2195
Practice Address - Fax:919-776-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01786OtherBCBS
NC6901786Medicaid
NC6901786Medicaid