NPIMap

Organization Active NPI

Lake Shore Physician PA

  • Internal Medicine Physician
  • Pasadena, MD
National Provider Identifier
1003823717
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D14751 Issued in MD
Legal business name
LAKE SHORE PHYSICIAN PA
Practice address
4231 Postal Court
Pasadena, MD 21122
Phone
(410) 432-3200
Fax
(410) 437-9402
NPI assigned
Aug 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carl Thomas Folkemer, MD
Title
President
Phone
(410) 437-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X D14751 MD Primary

Addresses

Primary practice location

4231 Postal Court
Pasadena, MD 21122

Mailing address

4231 Postal Court
Pasadena, MD 21122
Phone (410) 432-3200

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003823717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4231 POSTAL COURT",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "21122",
            "telephone_number": "410-432-3200",
            "fax_number": "410-437-9402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4231 POSTAL COURT",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "21122",
            "telephone_number": "410-432-3200",
            "fax_number": "410-437-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE PHYSICIAN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FOLKEMER",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-437-3200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D14751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.