Provider Demographics
NPI:1154948362
Name:HIBISCUS MEDICAL PLLC
Entity type:Organization
Organization Name:HIBISCUS MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRALEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-228-0719
Mailing Address - Street 1:430 GALLOWAY ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6312
Mailing Address - Country:US
Mailing Address - Phone:202-350-1546
Mailing Address - Fax:
Practice Address - Street 1:430 GALLOWAY ST NE STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6312
Practice Address - Country:US
Practice Address - Phone:202-350-1546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD124113300Medicaid
DC085010500Medicaid