1457403644 NPI number — FREDERICK ONCOLOGY HEMATOLOGY ASSOCIATES, P.C.

Table of content: (NPI 1457403644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457403644 NPI number — FREDERICK ONCOLOGY HEMATOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK ONCOLOGY HEMATOLOGY ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457403644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 THOMAS JOHNSON DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-695-6777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 BTHOMAS JOHNSON DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-695-6777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEGAZI
Authorized Official First Name:
A ZAKARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
301-695-6777

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218702700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010068746 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: QPB988 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0081294000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1457403644 . This is a "NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0196 . This is a "CAREFIRST FEDERAL /NASCO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4046819 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI1463 . This is a "R.R MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KF89FR . This is a "CAREFIRST MARYLANF" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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