Provider Demographics
NPI:1225335441
Name:FREDERICK COUNTY PEDIATRICS
Entity Type:Organization
Organization Name:FREDERICK COUNTY PEDIATRICS
Other - Org Name:FRED CO BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TZORTZINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-882-7489
Mailing Address - Street 1:11717 OLD NATIONAL PIKE
Mailing Address - Street 2:SUITE #8
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6154
Mailing Address - Country:US
Mailing Address - Phone:301-882-7489
Mailing Address - Fax:301-882-7520
Practice Address - Street 1:11717 OLD NATIONAL PIKE
Practice Address - Street 2:SUITE #8
Practice Address - City:NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21774-6154
Practice Address - Country:US
Practice Address - Phone:301-363-4663
Practice Address - Fax:240-782-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033531208000000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424890200Medicaid
D78113Medicare UPIN