Provider Demographics
NPI:1861626707
Name:FREDERICK PSYCHIATRIC MEDICINE
Entity Type:Organization
Organization Name:FREDERICK PSYCHIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:CORVIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-606-7785
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1945
Mailing Address - Country:US
Mailing Address - Phone:301-606-7785
Mailing Address - Fax:240-310-1927
Practice Address - Street 1:13218 BROOKLANE DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1435
Practice Address - Country:US
Practice Address - Phone:240-527-2082
Practice Address - Fax:240-310-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60054OtherAETNA
MDMDMCDMedicaid
MDSKMDOMedicaid
MDSB580OtherBC/BS
MDSX173OtherBEACON HEALTH
MD00823OtherVALUE OPTIONS
MDF97005Medicare UPIN