Provider Demographics
NPI:1427192715
Name:FREKKO PRIMARY CARE LLC
Entity Type:Organization
Organization Name:FREKKO PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIBOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREKKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-948-8780
Mailing Address - Street 1:818 WEST DIAMOND AVENUE
Mailing Address - Street 2:STE 130
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-948-8780
Mailing Address - Fax:301-519-9093
Practice Address - Street 1:818 WEST DIAMOND AVENUE
Practice Address - Street 2:STE 130
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-948-8780
Practice Address - Fax:301-519-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02283Medicare ID - Type UnspecifiedGROUP NUMBER