Organization
INTERNAL MEDICINE PRACTICE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KODUAH PEPRAH M.D. (DIRECTOR)
(301) 996-7900
Entity
Organization
Contact information
Practice address
324 E ANTIETAM ST STE 306, HAGERSTOWN, MD 21740-5768
(301) 739-0240
(301) 797-8546
Mailing address
18300 THUNDERCLOUD RD, BOYDS, MD 20841-4380
(301) 540-2076
(301) 540-5073
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336619700
—
MD
Enumeration date
09/29/2006
Last updated
02/06/2012
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