Provider Demographics
NPI:1386667681
Name:DIGESTIVE DISEASE CONSULTANT OF FREDERICK ENDOSCOPY STE
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CONSULTANT OF FREDERICK ENDOSCOPY STE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AMASA
Authorized Official - Last Name:FRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-662-7822
Mailing Address - Street 1:915 TOLL HOUSE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5901
Mailing Address - Country:US
Mailing Address - Phone:301-662-7822
Mailing Address - Fax:301-662-8883
Practice Address - Street 1:915 TOLL HOUSE AVE
Practice Address - Street 2:STE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5901
Practice Address - Country:US
Practice Address - Phone:301-662-7822
Practice Address - Fax:301-662-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1141261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
5149501OtherAETNA
235932OtherMAMSI
MD320271200Medicaid
5149501OtherAETNA