Provider Demographics
NPI:1427012053
Name:GASTROENTEROLOGY SPECIALISTS OF FREDERICK, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF FREDERICK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-663-9440
Mailing Address - Street 1:85 THOMAS JOHNSON CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4331
Mailing Address - Country:US
Mailing Address - Phone:301-663-9440
Mailing Address - Fax:301-663-4602
Practice Address - Street 1:85 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4331
Practice Address - Country:US
Practice Address - Phone:301-663-9440
Practice Address - Fax:301-663-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKG87OtherCAREFIRST BLUE CROSS/SHIE
MD641LMedicare ID - Type Unspecified