Provider Demographics
NPI:1780640755
Name:FRIZZERA, JOHN GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GORDON
Last Name:FRIZZERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-828-8077
Mailing Address - Fax:410-828-8078
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-828-8077
Practice Address - Fax:410-828-8078
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD004288207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD026521700Medicaid
MDH492N245Medicare PIN
MD026521700Medicaid