MEDICARE: CARDIOVASCULAR SPECIALISTS OF FREDERICK, LLC

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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1922034461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR SPECIALISTS OF FREDERICK, LLC

Provider Business Mailing Address
First Line	:	180 THOMAS JOHNSON DR
Second Line	:	202
City	:	FREDERICK
State	:	MD
Zip	:	21702-4409
Country	:	US
Telephone Number	:	301-631-6877
Fax Number	:	301-631-2428

Provider Business Practice Location Address
First Line	:	180 THOMAS JOHNSON DR
Second Line	:	202
City	:	FREDERICK
State	:	MD
Zip	:	21702-4409
Country	:	US
Telephone Number	:	301-631-6877
Fax Number	:	301-631-5211

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. DEBBIE K KLAUKA
Credential	:	MBA
Telephone Number	:	301-631-6877

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	01/21/2025

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