Healthcare Provider Details

I. General information

NPI: 1952427072
Provider Name (Legal Business Name): THE PEDIATRIC CENTER OF FREDERICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 201
FREDERICK MD
21702-4747
US

IV. Provider business mailing address

1475 TANEY AVE STE 201
FREDERICK MD
21702-4747
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-8053
  • Fax: 301-695-8604
Mailing address:
  • Phone: 301-631-8053
  • Fax: 301-695-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER M VANPELT
Title or Position: FRONT OFFICE COORDINATOR
Credential:
Phone: 301-631-8053