| Charter Internal Medicine, Llc | |
|
2470 Longstone Ln Ste I Marriottsville MD 21104-1523 | |
| (410) 910-2300 | |
| (410) 740-9134 |
| Full Name | Charter Internal Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2470 Longstone Ln Ste I, Marriottsville, Maryland |
| Authorized Official Name and Position | Randal P Riesett (PARTNER) |
| Authorized Official Contact | 4109102300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charter Internal Medicine, Llc 2470 Longstone Ln Ste I Marriottsville MD 21104-1523 Ph: (410) 910-2300 | Charter Internal Medicine, Llc 2470 Longstone Ln Ste I Marriottsville MD 21104-1523 Ph: (410) 910-2300 |
| NPI Number | 1750492419 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 11/14/2017 |
| Medicare PECOS PAC ID | 0244204113 |
|---|---|
| Medicare Enrollment ID | O20040825000968 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750492419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Randal Paul Riesett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396738779 PECOS PAC ID: 5092901033 Enrollment ID: I20101202000136 |
| Provider Name | Jonathan Scott Fish |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497748883 PECOS PAC ID: 8527255017 Enrollment ID: I20101209000804 |
Waverly Internal Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11165 Stratfield Ct, First Floor, Marriottsville, MD 21104 Phone: 410-442-8065 Fax: 410-442-8067 | |
Privia Medical Group, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2400 Longstone Ln Ste 106, Marriottsville, MD 21104 Phone: 410-770-2793 |