Provider Demographics
NPI:1386839488
Name:DMG INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:DMG INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-296-5792
Mailing Address - Street 1:111 EAST CATHERINE STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337
Mailing Address - Country:US
Mailing Address - Phone:570-296-5792
Mailing Address - Fax:973-859-7872
Practice Address - Street 1:111 E CATHERINE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1347
Practice Address - Country:US
Practice Address - Phone:570-296-5792
Practice Address - Fax:973-859-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059417L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG35632Medicare UPIN