Healthcare Provider Details

I. General information

NPI: 1013372986
Provider Name (Legal Business Name): GI WELLNESS CENTER OF FREDERICK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 THOMAS JOHNSON DR SUITE B&C
FREDERICK MD
21702-4742
US

IV. Provider business mailing address

165 THOMAS JOHNSON DR SUITE B&C
FREDERICK MD
21702-4742
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-4200
  • Fax:
Mailing address:
  • Phone: 301-620-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. SCOTT EDWARD ANDOCHICK
Title or Position: OWNER
Credential: M.D., D.D.S
Phone: 240-446-9855