Healthcare Provider Details

I. General information

NPI: 1922132281
Provider Name (Legal Business Name): FREDERICK ENT GROUP P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 THOMAS JOHNSON CT.
FREDERICK MD
21702-4348
US

IV. Provider business mailing address

82 THOMAS JOHNSON CT.
FREDERICK MD
21702-4348
US

V. Phone/Fax

Practice location:
  • Phone: 301-698-2440
  • Fax: 301-846-0892
Mailing address:
  • Phone: 301-698-2440
  • Fax: 301-846-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONG YOON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-698-2440