Provider Demographics
NPI:1013372986
Name:GI WELLNESS CENTER OF FREDERICK, LLC
Entity Type:Organization
Organization Name:GI WELLNESS CENTER OF FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ANDOCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:240-446-9855
Mailing Address - Street 1:165 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE B&C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4742
Mailing Address - Country:US
Mailing Address - Phone:301-620-4200
Mailing Address - Fax:
Practice Address - Street 1:165 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE B&C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4742
Practice Address - Country:US
Practice Address - Phone:301-620-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy