Provider Demographics
NPI:1447075353
Name:FREDERICK PEDIATRIC ASSOCIATES P.A.
Entity type:Organization
Organization Name:FREDERICK PEDIATRIC ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-694-0606
Mailing Address - Street 1:87 THOMAS JOHNSON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4427
Mailing Address - Country:US
Mailing Address - Phone:301-694-0606
Mailing Address - Fax:877-276-4919
Practice Address - Street 1:3500 CAMPUS DR STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7923
Practice Address - Country:US
Practice Address - Phone:301-874-6107
Practice Address - Fax:301-874-2496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK PEDIATRIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty