Divine Internal Medicine LLC
Internal Medicine in North East, MD. Organization (NPI-2).
NPI number1295032852
StatusActive
Last updated in NPPESJun 10, 2024
Details
- NPI
- 1295032852
- Entity type
- Organization (NPI-2)
- Legal business name
- Divine Internal Medicine LLC
- Organization subpart
- No
- Enumeration date
- Feb 17, 2011
- Certification date
- Sep 7, 2023
- Last updated
- Jun 10, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 207U00000X | Nuclear Medicine | – | – | |
| 2085R0202X | Radiology, Diagnostic Radiology | – | – |
Practice location
28 Flint DrNorth East, MD 21901-3746
Phone 443-877-6194 · Fax 443-877-6235
Mailing address
28 Flint DrNorth East, MD 21901-3746
Phone 443-877-6194 · Fax 443-877-6235
Authorized official
Cornelius Ope
Owner / President
4438776194
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