Healthcare Provider Details

I. General information

NPI: 1992358055
Provider Name (Legal Business Name): ALLERGY AND ASTHMA SPECIALISTS OF FREDERICK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 03/14/2020
Certification Date: 03/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 WESTVIEW DR STE 102
FREDERICK MD
21703-8372
US

IV. Provider business mailing address

1921 MORAN DR
FREDERICK MD
21702-6444
US

V. Phone/Fax

Practice location:
  • Phone: 240-831-4743
  • Fax: 240-831-4539
Mailing address:
  • Phone: 301-471-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALPA L. JANI
Title or Position: MEMBER AND EMPLOYEE
Credential: MD
Phone: 301-471-7120