Provider Demographics
NPI:1205625340
Name:ADVANCE INTERNAL MEDICINE PRIMARY CARE ,LLC
Entity type:Organization
Organization Name:ADVANCE INTERNAL MEDICINE PRIMARY CARE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:QAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-671-9284
Mailing Address - Street 1:1416 ASHBURY PARK PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-6404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2322 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2772
Practice Address - Country:US
Practice Address - Phone:937-424-5986
Practice Address - Fax:937-424-5989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty