Healthcare Provider Details

I. General information

NPI: 1790059491
Provider Name (Legal Business Name): FRANK W NEUBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 LOST TRAIL WAY
POTOMAC MD
20854-2094
US

IV. Provider business mailing address

9434 LOST TRAIL WAY
POTOMAC MD
20854-2094
US

V. Phone/Fax

Practice location:
  • Phone: 301-299-5244
  • Fax: 301-299-5245
Mailing address:
  • Phone: 301-299-5244
  • Fax: 301-299-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0007467
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: