| Geriatric Multispecialty Associates | |
|
11350 Pembrooke Sq Ste 311 Waldorf MD 20603-4809 | |
| (301) 870-0660 | |
| Not Available |
| Full Name | Geriatric Multispecialty Associates |
|---|---|
| Speciality | Internal Medicine |
| Location | 11350 Pembrooke Sq Ste 311, Waldorf, Maryland |
| Authorized Official Name and Position | Philip Wisotsky (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3018700660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geriatric Multispecialty Associates 11350 Pembrooke Sq Ste 311 Waldorf MD 20603-4809 Ph: () - | Geriatric Multispecialty Associates 11350 Pembrooke Sq Ste 311 Waldorf MD 20603-4809 Ph: (301) 870-0660 |
| NPI Number | 1316515372 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 11/22/2021 |
| Medicare PECOS PAC ID | 4082018767 |
|---|---|
| Medicare Enrollment ID | O20210803000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316515372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Carol G Boehm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821020884 PECOS PAC ID: 2466489471 Enrollment ID: I20050721000363 |
| Provider Name | Philip Wisotsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508862509 PECOS PAC ID: 0446387021 Enrollment ID: I20100430000354 |
| Provider Name | Tiffany Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043810146 PECOS PAC ID: 5890193783 Enrollment ID: I20211006003502 |
| Provider Name | Lorenda Beth Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063164507 PECOS PAC ID: 7113313453 Enrollment ID: I20220413001327 |
| Provider Name | Ivan Sabio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629047709 PECOS PAC ID: 8628029493 Enrollment ID: I20221220001463 |
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