Provider Demographics
NPI:1205843851
Name:SKOLNICK, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SKOLNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3509
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-5959
Mailing Address - Fax:410-414-4662
Practice Address - Street 1:130 HOSPITAL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-5959
Practice Address - Fax:410-414-4662
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00588562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61673604OtherCAREFIRST BCBS
MDJ7730003OtherCAREFIRST BCBS
MD400308000Medicaid
MD61673604OtherCAREFIRST BCBS
MDJ7730003OtherCAREFIRST BCBS