Healthcare Provider Details

I. General information

NPI: 1639283757
Provider Name (Legal Business Name): FREDERICK ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 THOMAS JOHNSON CT SUITE E
FREDERICK MD
21702-4331
US

IV. Provider business mailing address

602 CENTER ST SUITE 107
MOUNT AIRY MD
21771-7420
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-1600
  • Fax: 301-829-7694
Mailing address:
  • Phone: 301-829-7683
  • Fax: 301-829-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LEE JORDAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-829-7683