Healthcare Provider Details

I. General information

NPI: 1801212329
Provider Name (Legal Business Name): DR. JUDI FRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ALLENHURST CT
GAITHERSBURG MD
20878-1934
US

IV. Provider business mailing address

31 ALLENHURST CT
GAITHERSBURG MD
20878-1934
US

V. Phone/Fax

Practice location:
  • Phone: 301-679-0693
  • Fax: 301-670-0693
Mailing address:
  • Phone: 301-679-0693
  • Fax: 301-670-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1445
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: