| Internal Medicine Practice, P.a. | |
|
324 E Antietam St Ste 306 Hagerstown MD 21740-5768 | |
| (301) 739-0240 | |
| (301) 797-8546 |
| Full Name | Internal Medicine Practice, P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 324 E Antietam St Ste 306, Hagerstown, Maryland |
| Authorized Official Name and Position | Koduah Peprah (DIRECTOR) |
| Authorized Official Contact | 3019967900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Practice, P.a. 18300 Thundercloud Rd Boyds MD 20841-4380 Ph: (301) 540-2076 | Internal Medicine Practice, P.a. 324 E Antietam St Ste 306 Hagerstown MD 21740-5768 Ph: (301) 739-0240 |
| NPI Number | 1336231950 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 02/06/2012 |
| Medicare PECOS PAC ID | 8426005059 |
|---|---|
| Medicare Enrollment ID | O20050405001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336231950 | NPI | - | NPPES |
| 336619700 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Koduah Peprah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861584591 PECOS PAC ID: 1850375791 Enrollment ID: I20040617000120 |
| Provider Name | Richard Y. Koduah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609034628 PECOS PAC ID: 2961681952 Enrollment ID: I20110124000194 |
| Provider Name | Hannah Buekie Alorgbey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184176299 PECOS PAC ID: 8325311277 Enrollment ID: I20170829002137 |
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