Provider Demographics
NPI:1114972031
Name:MARYLAND INPATIENT MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:MARYLAND INPATIENT MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TALBOT
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-441-8500
Mailing Address - Street 1:PO BOX 96368
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-6368
Mailing Address - Country:US
Mailing Address - Phone:678-441-8500
Mailing Address - Fax:676-784-4186
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2913
Practice Address - Country:US
Practice Address - Phone:410-822-1000
Practice Address - Fax:410-770-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD356CMAOtherBCBS
MDDF5634OtherRR MEDICARE
MD412823100Medicaid
MD412823100Medicaid