Healthcare Provider Details

I. General information

NPI: 1265414023
Provider Name (Legal Business Name): OBGYN CENTER OF FREDERICK, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 THOMAS JOHNSON DR SUITE 101
FREDERICK MD
21702-4373
US

IV. Provider business mailing address

97 THOMAS JOHNSON DR SUITE 101
FREDERICK MD
21702-4373
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-4545
  • Fax: 301-663-1709
Mailing address:
  • Phone: 301-663-4545
  • Fax: 301-663-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN CHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 301-663-4545