Healthcare Provider Details

I. General information

NPI: 1790053361
Provider Name (Legal Business Name): FREDERICK HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 7TH ST
FREDERICK MD
21701-4586
US

IV. Provider business mailing address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-9573
  • Fax: 301-662-2182
Mailing address:
  • Phone: 301-663-9573
  • Fax: 301-662-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE K MAHAN
Title or Position: SR VP AND CFO
Credential:
Phone: 240-566-3355