Healthcare Provider Details

I. General information

NPI: 1922034461
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF FREDERICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 THOMAS JOHNSON DR 202
FREDERICK MD
21702-4409
US

IV. Provider business mailing address

180 THOMAS JOHNSON DR 202
FREDERICK MD
21702-4409
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-6877
  • Fax: 301-631-5211
Mailing address:
  • Phone: 301-631-6877
  • Fax: 301-631-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE K KLAUKA
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 301-631-6877