Provider Demographics
NPI:1922034461
Name:CARDIOVASCULAR SPECIALISTS OF FREDERICK, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF FREDERICK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLAUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:301-631-6877
Mailing Address - Street 1:180 THOMAS JOHNSON DR
Mailing Address - Street 2:202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4409
Mailing Address - Country:US
Mailing Address - Phone:301-631-6877
Mailing Address - Fax:301-631-2428
Practice Address - Street 1:180 THOMAS JOHNSON DR
Practice Address - Street 2:202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4409
Practice Address - Country:US
Practice Address - Phone:301-631-6877
Practice Address - Fax:301-631-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217101500Medicaid
MD217101500Medicaid