Provider Demographics
NPI:1477663979
Name:PIKESVILLE MEDICAL CARE
Entity Type:Organization
Organization Name:PIKESVILLE MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-1001
Mailing Address - Street 1:201 MILFORD MILL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5903
Mailing Address - Country:US
Mailing Address - Phone:410-484-1001
Mailing Address - Fax:410-484-1002
Practice Address - Street 1:201 MILFORD MILL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5903
Practice Address - Country:US
Practice Address - Phone:410-484-1001
Practice Address - Fax:410-484-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 225100000X
MD261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329PMedicare ID - Type UnspecifiedMEDICARE PROVIDER GROUP #