Healthcare Provider Details

I. General information

NPI: 1982109351
Provider Name (Legal Business Name): FREDERICK HEALTH HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 OPOSSUMTOWN PIKE STE 103
FREDERICK MD
21702-4337
US

IV. Provider business mailing address

400 W 7TH ST
FREDERICK MD
21701-4506
US

V. Phone/Fax

Practice location:
  • Phone: 240-566-4500
  • Fax:
Mailing address:
  • Phone: 240-566-3337
  • Fax: 240-566-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21D0692298
License Number StateMD

VIII. Authorized Official

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