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General NPI Number Information
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NPI Number | 1780092916
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Entity Type | Organization
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Legal Business Name | FREDERICK HEALTH MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 3430 WORTHINGTON BLVD
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City | FREDERICK
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State | MD
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Zip | 21704-7017
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Country | US
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Telephone | 301-874-2163
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Fax |
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Provider Business Mailing Address
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Address Line | 3430 WORTHINGTON BLVD
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City | FREDERICK
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State | MD
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Zip | 21704-7017
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Country | US
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Telephone | 301-874-2163
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Fax |
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Authorized Official
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Title or Position | SR. VP AND CFO
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Name | MICHELLE MAHAN
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Credential |
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Telephone | 240-566-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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