Healthcare Provider Details

I. General information

NPI: 1346162104
Provider Name (Legal Business Name): FAMILY UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 THOMAS JOHNSON DR STE 104
FREDERICK MD
21702-4471
US

IV. Provider business mailing address

186 THOMAS JOHNSON DR STE 104
FREDERICK MD
21702-4471
US

V. Phone/Fax

Practice location:
  • Phone: 301-606-0551
  • Fax: 301-606-1958
Mailing address:
  • Phone: 301-606-0551
  • Fax: 301-606-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED HASEEBUDDIN
Title or Position: PRESIDENT
Credential:
Phone: 301-606-0551