Organization
DIVINE INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORNELIUS OPE M.D. (OWNER / PRESIDENT)
(443) 877-6194
Entity
Organization
Contact information
Practice address
28 FLINT DR, NORTH EAST, MD 21901-3746
(443) 877-6194
(443) 877-6235
Mailing address
28 FLINT DR, NORTH EAST, MD 21901-3746
(443) 877-6194
(443) 877-6235
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207U00000X
Nuclear Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217678
MEDICARE PTAN
MD
Enumeration date
02/17/2011
Last updated
06/10/2024
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