Provider Demographics
NPI:1184347486
Name:CLARKSVILLE INTERNAL MEDICINE
Entity type:Organization
Organization Name:CLARKSVILLE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-254-6364
Mailing Address - Street 1:6124 RIPPLING TIDES TER
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1535
Mailing Address - Country:US
Mailing Address - Phone:443-248-1727
Mailing Address - Fax:888-560-5303
Practice Address - Street 1:6124 RIPPLING TIDES TER
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1535
Practice Address - Country:US
Practice Address - Phone:443-248-1727
Practice Address - Fax:888-560-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty