Provider Demographics
NPI:1033305263
Name:FREDERICK KIDNEY CARE ASSOCIATES LLC.
Entity Type:Organization
Organization Name:FREDERICK KIDNEY CARE ASSOCIATES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-696-0012
Mailing Address - Street 1:5205 CHAIRMANS CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2915
Mailing Address - Country:US
Mailing Address - Phone:301-696-0012
Mailing Address - Fax:
Practice Address - Street 1:5205 CHAIRMANS CT
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2915
Practice Address - Country:US
Practice Address - Phone:301-696-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW12133963261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty