Provider Demographics
NPI:1962539056
Name:INTERNAL MEDICINE CENTER PA
Entity type:Organization
Organization Name:INTERNAL MEDICINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-9170
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-9170
Mailing Address - Fax:301-654-5893
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-9170
Practice Address - Fax:301-654-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23116Medicare UPIN
G22764Medicare UPIN
C61720Medicare UPIN
C62688Medicare UPIN
G96004Medicare UPIN
D09268Medicare UPIN
C88473Medicare UPIN
C62090Medicare UPIN
B93943Medicare UPIN