Provider Demographics
NPI:1689658890
Name:FREDERICK PRIMARY CARE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FREDERICK PRIMARY CARE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-663-6162
Mailing Address - Street 1:610 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-8624
Mailing Address - Country:US
Mailing Address - Phone:301-663-6162
Mailing Address - Fax:
Practice Address - Street 1:610 SOLAREX CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8624
Practice Address - Country:US
Practice Address - Phone:301-682-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD926580501Medicaid
MD926580505Medicaid
MD926580509Medicaid
MD926580502Medicaid
MD926580504Medicaid
MD926580503Medicaid
MD926580507Medicaid
MD926580506Medicaid
MD926580508Medicaid
MDCD8143Medicare PIN
MD451LMedicare PIN