Provider Demographics
NPI:1023118221
Name:MID-SHORE INTERNAL MEDICINE,LLC
Entity type:Organization
Organization Name:MID-SHORE INTERNAL MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:REINBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-754-5505
Mailing Address - Street 1:321 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-1727
Mailing Address - Country:US
Mailing Address - Phone:410-754-5505
Mailing Address - Fax:410-754-5544
Practice Address - Street 1:321 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-1727
Practice Address - Country:US
Practice Address - Phone:410-754-5505
Practice Address - Fax:410-754-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD144000400Medicaid
MD250MMedicare PIN
MD144000400Medicaid