Healthcare Provider Details

I. General information

NPI: 1750109435
Provider Name (Legal Business Name): FREDERICK METABOLIC AND PRIMARY CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 THOMAS JOHNSON DR STE 201
FREDERICK MD
21702-4562
US

IV. Provider business mailing address

184 THOMAS JOHNSON DR STE 201
FREDERICK MD
21702-4562
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-2806
  • Fax:
Mailing address:
  • Phone: 240-949-7519
  • Fax: 240-450-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAFRINA HASAN
Title or Position: OWNER / CLINICIAN
Credential: MD
Phone: 516-650-2806