Can Internal Medicine Providers Practice in Multiple States? Challenges and Path Forward

Introduction

Maryland's position along the DC, Virginia, Pennsylvania, Delaware, and West Virginia borders means a real share of internal medicine practices eventually consider seeing patients across state lines. This guide covers whether that's actually possible, how the Interstate Medical Licensure Compact works, what changes with telehealth, and the credentialing and payer enrollment steps involved in expanding a Maryland internal medicine practice into another state.

The honest answer is yes, but it's not automatic. Medical licensure is state-specific by default, and multi-state practice, whether through in-person care near a border or telehealth reaching patients in another state entirely, requires navigating separate licensing, credentialing, and payer enrollment processes for each state involved. This guide walks through what's actually required, how the Interstate Medical Licensure Compact changes the picture for Maryland physicians, and what a realistic path to multi-state practice looks like.

Can an Internal Medicine Provider Practice in Multiple States?

Physicians can practice in multiple states, but each state requires its own medical license, since licensure is granted and regulated at the state level rather than nationally. There's no federal medical license that authorizes practice everywhere. A Maryland-licensed internist wanting to see patients physically located in Virginia or Pennsylvania needs a separate, valid license in that state too.

This applies whether the multi-state practice involves a physical second office, a physician who splits time between locations, or purely telehealth encounters with patients located in another state. The key legal principle across nearly every framework, including the compact discussed below, is that the practice of medicine is considered to occur where the patient is physically located at the time of the encounter, not where the physician happens to be sitting.

Multi-State Medical Licensing

Traditional multi-state licensing means applying separately to each state medical board, a process that historically could take months per state and involves separate fees, separate primary source verification, and separate ongoing renewal and continuing education requirements. For a Maryland internist considering expansion into a neighboring state, that traditional path is still available, and for states outside the Interstate Medical Licensure Compact, it's the only path.

The administrative weight of this shouldn't be underestimated. Each state license carries its own renewal cycle, its own continuing medical education requirements, and its own reporting obligations, all of which need to be tracked independently even after the initial licensing hurdle is cleared. A practice in Frederick considering expansion toward the Pennsylvania border, for example, would need to manage Maryland and Pennsylvania licensure as two entirely separate ongoing obligations, unless both states happen to be part of a compact framework that simplifies the process.

What Is the Interstate Medical Licensure Compact?

The Interstate Medical Licensure Compact, known as the IMLC, is exactly the kind of simplified pathway that changes this calculation for many Maryland physicians. The IMLC creates an expedited licensing process for physicians seeking licenses in multiple participating states, without changing any individual state's underlying medical practice act. A physician still ends up holding a full, separate license in each state, but the application process itself is streamlined through a shared framework rather than requiring an entirely independent application to each state board.

Maryland has participated in the IMLC since July 1, 2019, according to the Maryland Board of Physicians, making it one of the earlier states to join. As of 2026, the compact includes more than 40 member states along with the District of Columbia and Guam, and participation has continued to grow, with additional states joining as recently as this year. That said, not every state participates. California, New York, and Florida, as of early 2026, remain outside the compact, which means a Maryland physician with patients in those specific states still needs to pursue traditional, separate licensure there.

One important, current detail for Maryland physicians specifically: starting July 15, 2026, holders of a Maryland-issued Compact license must complete a two-step renewal process, submitting a renewal application and fee directly to the IMLC, and separately completing the Maryland Board of Physicians' own license renewal by September 30, 2026. Missing either step results in the Maryland-issued license expiring, which means the physician is no longer authorized to practice in Maryland at all, not just unable to renew the compact pathway. This is a detail worth flagging directly to any physician or administrator managing IMLC-based licensure in the state.

Telehealth and Multi-State Internal Medicine

Telehealth adds its own layer to this picture, and it's a particularly relevant one for internal medicine, given how much chronic disease management translates well to virtual follow-up visits. The core rule doesn't change with the delivery method: since the practice of medicine is deemed to occur where the patient is located, a Maryland internist providing a telehealth visit to a patient physically sitting in Virginia still needs to be licensed in Virginia for that encounter, exactly as if the visit happened in person.

This matters enormously for practices near Maryland's borders. A patient who splits time between a Maryland home and a Delaware beach property, or a patient who works in DC but lives in Bowie, can create exactly this kind of multi-state telehealth scenario without either party necessarily realizing licensure requirements have shifted. Practices offering telehealth to patients in Washington, DC, Virginia, Pennsylvania, Delaware, or West Virginia, all IMLC member jurisdictions as of 2026, can generally use the compact's streamlined pathway. Reaching a patient temporarily in a non-compact state requires the traditional licensing route instead.

Credentialing Multiple States and Payers

Getting licensed is only the first step. Payer credentialing runs on its own separate track, and it doesn't automatically follow licensure the way some physicians assume it will. Each payer relationship(provider roster and payer enrollment), Medicare through PECOS, each state's Medicaid program, and every commercial payer, needs its own credentialing process specific to that state, even when the underlying medical license was obtained efficiently through the IMLC.

This means a Maryland practice expanding into Virginia, for instance, needs to separately credential with Virginia Medicaid, confirm whether existing commercial payer contracts extend to Virginia or require a distinct enrollment, and update CAQH profile information to reflect the new practice location and licensure. A practice in Rockville or Bethesda expanding telehealth reach into DC specifically needs to work through DC's own Medicaid credentialing process independently of whatever Maryland Medicaid relationship already exists. None of this happens automatically just because the physician now holds a valid license in the new jurisdiction.

Challenges of Multi-State Internal Medicine Practice

A few recurring challenges show up consistently for Maryland practices pursuing multi-state expansion. Licensing timelines, even through the IMLC, still take real weeks to process and require upfront planning rather than last-minute action. Payer credentialing in a new state can lag well behind licensure, creating a gap where a physician is legally licensed but not yet able to bill certain payers for services in that state. Tracking separate continuing education, renewal, and reporting requirements across multiple state licenses adds ongoing administrative burden that doesn't end once the initial expansion is complete. And coordinating which specific payers, Medicaid programs, and commercial network relationships actually apply in each state requires careful, state-by-state tracking rather than an assumption that Maryland's existing payer relationships simply extend outward.

Step-by-Step Path to Expanding Across States

1. Confirm whether the target state participates in the IMLC. This determines whether the streamlined compact pathway or traditional individual licensure applies.
2. Apply for licensure in the new state, through the IMLC where available, or through the state's traditional application process otherwise.
3. Confirm Medicare enrollment covers the new practice location through PECOS, updating provider information as needed.
4. Begin state Medicaid credentialing separately for the new state, since this does not transfer automatically from Maryland Medicaid enrollment.
5. Review and update commercial payer contracts to confirm whether they extend to the new state or require independent enrollment.
6. Update CAQH profile information to reflect new licensure and practice locations accurately.
7. Build tracking for the new state's renewal, continuing education, and reporting requirements alongside existing Maryland obligations.

Multi-State Practice Checklist

1. Confirm target state's IMLC participation status
2. Complete licensure application through the appropriate pathway
3. Verify Medicare PECOS enrollment reflects the new location
4. Complete separate state Medicaid credentialing
5. Confirm commercial payer network status in the new state
6. Update CAQH profile with current licensure and location details
7. Track separate renewal and CE deadlines for each state license
8. Confirm telehealth-specific requirements for any state where care is delivered virtually

Frequently Asked Questions

Can an internal medicine physician be licensed in more than one state at the same time?

Yes. Physicians can hold active medical licenses in multiple states simultaneously, though each license is separate, with its own renewal cycle and continuing education requirements.

Is Maryland part of the Interstate Medical Licensure Compact?

Yes. Maryland has participated in the IMLC since July 1, 2019, according to the Maryland Board of Physicians, and continues to be an active member state as of 2026.

Does a Maryland medical license automatically allow telehealth visits with patients in other states?

No. Since the practice of medicine is considered to occur where the patient is located, a Maryland physician needs separate licensure in any state where a telehealth patient is physically located during the visit.

Does getting licensed in a new state automatically enroll a physician with that state's payers?

No. Licensure and payer credentialing are separate processes. A physician needs to complete distinct credentialing with Medicare, each state Medicaid program, and commercial payers in the new state, regardless of how the license itself was obtained.

Which states near Maryland are part of the IMLC?

Washington, DC, Virginia, Pennsylvania, Delaware, and West Virginia are all IMLC member jurisdictions as of 2026, meaning Maryland physicians expanding into these bordering states can generally use the compact's streamlined licensing pathway.

What happens if a Maryland IMLC license isn't renewed properly?

Starting July 15, 2026, Maryland IMLC license holders must complete both an IMLC renewal step and a separate Maryland Board of Physicians renewal by September 30, 2026. Missing either step results in the Maryland-issued license expiring, meaning the physician is no longer authorized to practice in Maryland.

Conclusion

Multi-state internal medicine practice is genuinely achievable for Maryland physicians, and the Interstate Medical Licensure Compact has made the licensing side of it considerably more manageable than it once was for practices expanding toward DC, Virginia, Pennsylvania, Delaware, or West Virginia. What hasn't gotten simpler is everything that comes after licensure, payer credentialing, Medicaid enrollment, and ongoing multi-state compliance tracking still require deliberate, state-by-state attention to avoid revenue leakage. Practices in border communities from Hagerstown to Elkton to Bethesda that plan for both halves of this process, licensing and credentialing, tend to expand far more smoothly than those that assume one automatically follows the other.

Edge RCM CTA

Expanding an internal medicine practice across state lines multiplies credentialing and payer enrollment complexity well beyond what a single Maryland license requires. Edge RCM, based in Reisterstown, helps Maryland practices coordinate multi-state credentialing, payer enrollment and billing processes as they expand into neighboring states, so licensure progress doesn't outpace the administrative work needed to actually bill for care in a new jurisdiction.