Provider Demographics
NPI:1639304215
Name:ADVANCED PULMONARY AND SLEEP ASSOCIATES OF FREDERICK, LLC
Entity Type:Organization
Organization Name:ADVANCED PULMONARY AND SLEEP ASSOCIATES OF FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDUSAR
Authorized Official - Middle Name:IKRAM
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-405-7347
Mailing Address - Street 1:9114 HENDRY TER
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7814
Mailing Address - Country:US
Mailing Address - Phone:240-405-7347
Mailing Address - Fax:
Practice Address - Street 1:801 TOLL HOUSE AVE STE D2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6112
Practice Address - Country:US
Practice Address - Phone:240-405-7347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty