Basic Information
| Provider Information | |||||||||
| NPI: | 1700065042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNAL MEDICINE PARTNERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1347 | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187040347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702888881 | ||||||||
| FaxNumber: | 5702888065 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 SHOEMAKER AVE | ||||||||
| Address2: | |||||||||
| City: | WEST WYOMING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186441120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706934020 | ||||||||
| FaxNumber: | 5706932123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2007 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | ADAJAR | ||||||||
| AuthorizedOfficialFirstName: | MARIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5706934020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD420488 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.