Provider Demographics
NPI:1760590111
Name:FREDERICK INTERNAL MEDICINE AND ENDOCRINOLOGY SERVICES PA
Entity Type:Organization
Organization Name:FREDERICK INTERNAL MEDICINE AND ENDOCRINOLOGY SERVICES PA
Other - Org Name:DONELSON & CARNELL MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-732-5864
Mailing Address - Street 1:65 THOMAS JOHNSON DR
Mailing Address - Street 2:STE C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4371
Mailing Address - Country:US
Mailing Address - Phone:301-663-3836
Mailing Address - Fax:301-663-0122
Practice Address - Street 1:65 THOMAS JOHNSON DR
Practice Address - Street 2:STE C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4371
Practice Address - Country:US
Practice Address - Phone:301-663-3836
Practice Address - Fax:301-663-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK935Medicare PIN