Provider Demographics
NPI:1588660385
Name:FREDERICK J SAUERBURGER MD PA
Entity Type:Organization
Organization Name:FREDERICK J SAUERBURGER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAUERBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-843-3120
Mailing Address - Street 1:11345 PEMBROOKE SQUARE
Mailing Address - Street 2:STE 105
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603
Mailing Address - Country:US
Mailing Address - Phone:301-843-3120
Mailing Address - Fax:301-645-4740
Practice Address - Street 1:11345 PEMBROOKE SQUARE
Practice Address - Street 2:STE 105
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603
Practice Address - Country:US
Practice Address - Phone:301-843-3120
Practice Address - Fax:301-645-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD212291000152W00000X
MDKN29207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8185OtherCAREFIRST OF DC
MD212291000Medicaid
MDKN29FROtherCAREFIRST OF MD
MDKN29Medicare PIN
MDKN29FROtherCAREFIRST OF MD
DC8185OtherCAREFIRST OF DC