Provider Demographics
NPI:1558825307
Name:IDEAL ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:IDEAL ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:CORNELIA
Authorized Official - Last Name:FRATILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-847-5511
Mailing Address - Street 1:7 CHARLESBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1205
Mailing Address - Country:US
Mailing Address - Phone:443-847-5511
Mailing Address - Fax:
Practice Address - Street 1:3000 CHESTNUT AVE STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2794
Practice Address - Country:US
Practice Address - Phone:443-842-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184735656OtherNPI