Healthcare Provider Details

I. General information

NPI: 1841782836
Provider Name (Legal Business Name): FREDERICK HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
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
21701-4593
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6310
  • Fax: 301-365-2581
Mailing address:
  • Phone: 240-566-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE K. MAHAN
Title or Position: CFO
Credential:
Phone: 240-566-3337