Basic Information
| Provider Information | |||||||||
| NPI: | 1477629681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNAPOLIS INTERNAL MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 DEFENSE HWY | ||||||||
| Address2: | STE 400 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108979841 | ||||||||
| FaxNumber: | 4108979852 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 DEFENSE HWY | ||||||||
| Address2: | STE 400 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108979841 | ||||||||
| FaxNumber: | 4108979852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOLDSTEIN | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4108979841 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.