MEDICARE: DR. FREDERICK JEROME CORDER MD

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
1	208000000X	Pediatrics Physician	D0025675	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5217055205	OTHER		FIN

General Provider Information

NPI Number	:	1427196740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK JEROME CORDER MD

Provider Business Mailing Address
First Line	:	1206 GOLF COURSE DR
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-2325
Country	:	US
Telephone Number	:	301-446-7294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 RHODE ISLAND AVE
Second Line	:
City	:	BRENTWOOD
State	:	MD
Zip	:	20722-1435
Country	:	US
Telephone Number	:	301-887-1840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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