Provider Demographics
NPI:1265689707
Name:FRICKE, DAVID WALTER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WALTER
Last Name:FRICKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 GROVERS TURN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3230
Mailing Address - Country:US
Mailing Address - Phone:301-855-4622
Mailing Address - Fax:707-222-0354
Practice Address - Street 1:395 GROVERS TURN RD
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3230
Practice Address - Country:US
Practice Address - Phone:301-855-4622
Practice Address - Fax:707-222-0354
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023009207P00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD70375Medicare UPIN
21226322Medicare PIN