Lake Shore Physician PA

NPI #1003823717 in Pasadena, Maryland

Provider Information

NPI Number: 1003823717
Entity Type: Organization
Organization Name: Lake Shore Physician PA
Primary Specialty: Internal Medicine
Enumeration Date: Aug 2, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 4231 POSTAL COURT
City: Pasadena
State: Maryland
ZIP Code: 21122
Phone: (410) 432-3200

Authorized Official

Name: CARL THOMAS FOLKEMER, MD
Title: PRESIDENT
Phone: (410) 437-3200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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