Provider Demographics
NPI:1205827664
Name:FREDERICK CARDIOVASCULAR CARE PC
Entity Type:Organization
Organization Name:FREDERICK CARDIOVASCULAR CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-682-3370
Mailing Address - Street 1:97 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4379
Mailing Address - Country:US
Mailing Address - Phone:301-682-3370
Mailing Address - Fax:301-682-3377
Practice Address - Street 1:97 THOMAS JOHNSON DR
Practice Address - Street 2:STE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4379
Practice Address - Country:US
Practice Address - Phone:301-682-3370
Practice Address - Fax:301-682-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0039804207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG4370001OtherBCBS
MD0F53FROtherBCBS
3001500OtherAETNA HMO
4126583OtherAETNA NON HMO
42222OtherMAMSI
MD0F53FROtherBCBS
C33086Medicare UPIN