Basic Information
| Provider Information | |||||||||
| NPI: | 1689658890 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FREDERICK PRIMARY CARE ASSOCIATES, P.A. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SOLAREX CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217038624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016636162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 SOLAREX CT | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217038624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016825500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3016636162 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 926580501 | 05 | MD | MEDICAID | 926580505 | 05 | MD | MEDICAID | 926580509 | 05 | MD | MEDICAID | 926580502 | 05 | MD | MEDICAID | 926580504 | 05 | MD | MEDICAID | 926580503 | 05 | MD | MEDICAID | 926580507 | 05 | MD | MEDICAID | 926580506 | 05 | MD | MEDICAID | 926580508 | 05 | MD | MEDICAID |