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Frederick, Maryland

Provider NPI: 1083619951

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 301-695-8390  Fax: 301-694-7906

Business Mailing Address:
Tel: 301-695-8390  Fax: 301-694-7906

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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