Healthcare Provider Details

I. General information

NPI: 1013033778
Provider Name (Legal Business Name): JEANETTE E FORONDA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1562 OPOSSUMTOWN PIKE
FREDERICK MD
21702-4920
US

IV. Provider business mailing address

1 FREDERICK HEALTH WAY
FREDERICK MD
21701-9435
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6310
  • Fax: 240-566-7754
Mailing address:
  • Phone: 240-215-6310
  • Fax: 240-566-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003752
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062204
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: