Clarksville Internal Medicine
Organization Active NPI Internal Medicine Physician · Clarksville, MD
NPI 1184347486 · NPPES record last updated Sep 21, 2022
Key facts
- NPI
- 1184347486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CLARKSVILLE INTERNAL MEDICINE
- Practice address
- 6124 Rippling Tides Ter
Clarksville, MD 21029-1535 - Phone
- (443) 248-1727
- Fax
- (888) 560-5303
- NPI assigned
- Sep 21, 2022
- Organization subpart
- No
Authorized official
- Name
- Dona Bowie
- Title
- Billing Manager
- Phone
- (301) 254-6364
Practitioners 5
-
Khawaja A Farooq, MD
-
Syed Ashraf Ali, PA-C
-
Andrea Adenike Coker, FNP-BC
-
Jonathan Damon Lawless, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221101002557 | MD | Part B Supplier - Clinic/Group Practice | 3971970120 |
Receives reassigned benefits from 3 practitioners Practice locations: Clarksville, MD; Ellicott City, MD; Mount Airy, MD |
National Provider Directory
Locations
4101 Old National Pike
Mount Airy, MD 21771
Phone (301) 829-0800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
6124 Rippling Tides Ter
Clarksville, MD 21029-1535
Mailing address
6124 Rippling Tides Ter
Clarksville, MD 21029-1535
Phone (443) 248-1727
Other providers in Clarksville, MD
- Child and Adult Psychiatry Services LLC
- Choice Care Health Group
- Racheal Clark
- Clarksville Chiropractic Health Center, PA
- Clarksville Crossing Dental, LLC
- Linda Louise Cliff
- Bridget McCaffrey Collier
- John Patrick Collins
- Tara Collins
- Columbia Family Eye Care, Inc.
All providers in Clarksville, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.