# LAKE SHORE PHYSICIAN PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003823717
- **Authorized official:** CARL THOMAS FOLKEMER MD (PRESIDENT)
- **Authorized official phone:** (410) 437-3200

## Contact information

- **Practice address:** 4231 POSTAL COURT, PASADENA, MD 21122
- **Practice address phone:** (410) 432-3200
- **Practice address fax:** (410) 437-9402
- **Mailing address:** 4231 POSTAL COURT, PASADENA, MD 21122
- **Mailing address phone:** (410) 432-3200
- **Mailing address fax:** (410) 437-9402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | D14751 | MD | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 08/22/2020