| Divine Internal Medicine Llc | |
|
28 Flint Dr North East MD 21901-3746 | |
| (443) 877-6194 | |
| (443) 877-6235 |
| Full Name | Divine Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 28 Flint Dr, North East, Maryland |
| Authorized Official Name and Position | Cornelius Ope (OWNER / PRESIDENT) |
| Authorized Official Contact | 4438776194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Internal Medicine Llc 28 Flint Dr North East MD 21901-3746 Ph: (443) 877-6194 | Divine Internal Medicine Llc 28 Flint Dr North East MD 21901-3746 Ph: (443) 877-6194 |
| NPI Number | 1295032852 |
|---|---|
| Provider Enumeration Date | 02/17/2011 |
| Last Update Date | 06/10/2024 |
| Medicare PECOS PAC ID | 3476730714 |
|---|---|
| Medicare Enrollment ID | O20110614000147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295032852 | NPI | - | NPPES |
| 217678 | Other | MD | MEDICARE PTAN |
| Provider Name | Cornelius O Ope |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629066188 PECOS PAC ID: 2264409283 Enrollment ID: I20090708000322 |
| Provider Name | Ema Ndi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043649767 PECOS PAC ID: 5597055764 Enrollment ID: I20160825002021 |
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