Healthcare Provider Details

I. General information

NPI: 1033605902
Provider Name (Legal Business Name): FREDERICK HEALTH HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 7TH ST
FREDERICK MD
21701-4586
US

IV. Provider business mailing address

400 W 7TH ST
FREDERICK MD
21701-4506
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6310
  • Fax:
Mailing address:
  • Phone: 240-566-3337
  • Fax: 240-566-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELBY K. BOGGS
Title or Position: VP AND CEO
Credential:
Phone: 240-566-3337