Healthcare Provider Details

I. General information

NPI: 1285961383
Provider Name (Legal Business Name): FREDERICK UROSURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAUGHMANS LN SUITE 201
FREDERICK MD
21702-4059
US

IV. Provider business mailing address

110 BAUGHMANS LN SUITE 201
FREDERICK MD
21702-4059
US

V. Phone/Fax

Practice location:
  • Phone: 301-694-8080
  • Fax: 301-694-8089
Mailing address:
  • Phone: 301-694-8080
  • Fax: 301-694-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. MOHAMMED M MOHIUDDIN
Title or Position: OWNER
Credential: M.D.
Phone: 301-694-8080