Provider Demographics
NPI:1437171311
Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND GERIATRICS ASSOCIATES LLC
Other - Org Name:IMG ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP, CMD
Authorized Official - Phone:843-343-3188
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-0459
Mailing Address - Country:US
Mailing Address - Phone:843-343-3188
Mailing Address - Fax:843-824-9342
Practice Address - Street 1:9319 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9103
Practice Address - Country:US
Practice Address - Phone:843-343-3188
Practice Address - Fax:843-824-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22387207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH309668542OtherMEDICARE PIN
SCGP4445Medicaid
SCH309668542OtherMEDICARE PIN