| Lake Shore Physician Pa | |
|
4231 Postal Court Pasadena MD 21122 | |
| (410) 432-3200 | |
| (410) 437-9402 |
| Full Name | Lake Shore Physician Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 4231 Postal Court, Pasadena, Maryland |
| Authorized Official Name and Position | Carl Thomas Folkemer (PRESIDENT) |
| Authorized Official Contact | 4104373200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Shore Physician Pa 4231 Postal Court Pasadena MD 21122 Ph: (410) 432-3200 | Lake Shore Physician Pa 4231 Postal Court Pasadena MD 21122 Ph: (410) 432-3200 |
| NPI Number | 1003823717 |
|---|---|
| Provider Enumeration Date | 08/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003823717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D14751 (Maryland) | Primary |
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