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General NPI Number Information
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NPI Number | 1972658706
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Entity Type | Organization
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Legal Business Name | FREDERICKTOWN AMBULATORY SURGICAL FACILITY, INC.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 198 THOMAS JOHNSON DR SUITE 101
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City | FREDERICK
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State | MD
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Zip | 21702-4398
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Country | US
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Telephone | 301-694-0870
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Fax | 301-694-7034
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Provider Business Mailing Address
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Address Line | 198 THOMAS JOHNSON DR SUITE 101
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City | FREDERICK
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State | MD
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Zip | 21702-4398
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Country | US
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Telephone | 301-694-0870
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Fax | 301-694-7034
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Authorized Official
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Title or Position | PRESEIDENT
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Name | DR. VINCENT EDWIN DIFABIO
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Credential | D.D.S.
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Telephone | 30169040870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1166
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License Number State | MD
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