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NPI Code Detail

MEDICARE: FREDERICK PRIMARY CARE ASSOCIATES, P.A.

MEDICARE: FREDERICK PRIMARY CARE ASSOCIATES, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian
2207RE0101XEndocrinology, Diabetes & Metabolism Physician
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1346075546
Entity Type Code : Organization
Provider Name (Legal Business Name) : FREDERICK PRIMARY CARE ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 610 SOLAREX CT
Second Line :
City : FREDERICK
State : MD
Zip : 21703-8624
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3430 WORTHINGTON BLVD STE 103
Second Line :
City : FREDERICK
State : MD
Zip : 21704-7018
Country : US
Telephone Number : 240-215-6900
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. SCOTT R LILLY
Credential :
Telephone Number : 301-663-6162
Provider Enumeration Date : 09/06/2024
Last Update Date : 02/27/2025

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