Healthcare Provider Details

I. General information

NPI: 1740819457
Provider Name (Legal Business Name): DR. NICHOLAS FIFELSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR STE 170
FREDERICK MD
21702-4530
US

IV. Provider business mailing address

141 THOMAS JOHNSON DR STE 170
FREDERICK MD
21702-4530
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9707
  • Fax: 301-668-4927
Mailing address:
  • Phone: 301-668-9707
  • Fax: 301-668-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01756
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: