Healthcare Provider Details

I. General information

NPI: 1679403976
Provider Name (Legal Business Name): M MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6012 JEFFERSON BLVD
FREDERICK MD
21703-6953
US

IV. Provider business mailing address

6 E EAGER ST
BALTIMORE MD
21202-2506
US

V. Phone/Fax

Practice location:
  • Phone: 301-371-7160
  • Fax:
Mailing address:
  • Phone: 410-520-1435
  • Fax: 410-431-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRYSTLE D BROWN
Title or Position: BILLING MANAGER
Credential:
Phone: 410-800-6251