Provider Demographics
NPI:1336403237
Name:FOX, DERRICK ALWYN (MD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:ALWYN
Last Name:FOX
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 1:11055 LITTLE PATUXENT PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2898
Mailing Address - Country:US
Mailing Address - Phone:443-858-8917
Mailing Address - Fax:
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY STE 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2898
Practice Address - Country:US
Practice Address - Phone:443-858-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO0919362084N0008X
NC2018-011932084N0400X
IL0361500582084N0400X
MDD00919362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine