Provider Demographics
NPI:1417232513
Name:FREDERICK INSTITUTE
Entity Type:Organization
Organization Name:FREDERICK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-663-4130
Mailing Address - Street 1:5716 INDUSTRY LN STE C
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5202
Mailing Address - Country:US
Mailing Address - Phone:301-663-4130
Mailing Address - Fax:
Practice Address - Street 1:5716 INDUSTRY LN STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5202
Practice Address - Country:US
Practice Address - Phone:301-663-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903854261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD721210100Medicaid