Provider Demographics
NPI:1154310340
Name:INTRAMED INFUSION CENTER PA
Entity Type:Organization
Organization Name:INTRAMED INFUSION CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-604-8000
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5268
Mailing Address - Country:US
Mailing Address - Phone:301-604-8000
Mailing Address - Fax:301-604-4406
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5268
Practice Address - Country:US
Practice Address - Phone:301-604-8000
Practice Address - Fax:301-604-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20251207RI0200X
MDM07210207RI0200X
MDAS9323522207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5031-0001OtherBC DC
MDG01179Medicare ID - Type Unspecified
C62530Medicare UPIN