Healthcare Provider Details

I. General information

NPI: 1508840026
Provider Name (Legal Business Name): JOSEPH ASHWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 THOMAS JOHNSON DR
FREDERICK MD
21702-4599
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-3111
  • Fax: 301-694-8626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0026609
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD0026609
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: