Healthcare Provider Details

I. General information

NPI: 1659330066
Provider Name (Legal Business Name): ALLAN J MONFRIED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 GENERALS HWY
ANNAPOLIS MD
21401-7488
US

IV. Provider business mailing address

PO BOX 6725
ANNAPOLIS MD
21401-0725
US

V. Phone/Fax

Practice location:
  • Phone: 410-451-2116
  • Fax: 410-721-2656
Mailing address:
  • Phone: 443-332-4260
  • Fax: 410-721-7851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD007144
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: