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General NPI Number Information
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NPI Number | 1306135801
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Entity Type | Organization
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Legal Business Name | FREDERICK'S RADIOLOGY & DIAGNOSTIC CENTER, LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1003 W 7TH ST SUITE 1001
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City | FREDERICK
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State | MD
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Zip | 21701-4106
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Country | US
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Telephone | 240-439-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 W 7TH ST SUITE 1001
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City | FREDERICK
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State | MD
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Zip | 21701-4106
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Country | US
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Telephone | 240-439-4405
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SILVIO PEREZ
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Credential |
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Telephone | 30413667338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | MD
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