Provider Demographics
NPI:1114119336
Name:FREDERICK RENAL CARE LLC.
Entity Type:Organization
Organization Name:FREDERICK RENAL CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEISTER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-696-2290
Mailing Address - Street 1:405 W 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4505
Mailing Address - Country:US
Mailing Address - Phone:301-696-2290
Mailing Address - Fax:301-696-5580
Practice Address - Street 1:405 W SEVENTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4505
Practice Address - Country:US
Practice Address - Phone:301-696-2290
Practice Address - Fax:301-696-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212654Medicare Oscar/Certification