Provider Demographics
NPI:1669401857
Name:FLESSNER, MICHAEL F (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:FLESSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 S MARKET ST
Mailing Address - Street 2:FREDERICK COMMUNITY ACTION AGENCY
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5527
Mailing Address - Country:US
Mailing Address - Phone:301-600-1506
Mailing Address - Fax:301-662-9079
Practice Address - Street 1:100 S MARKET ST
Practice Address - Street 2:FREDERICK COMMUNITY ACTION AGENCY
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5527
Practice Address - Country:US
Practice Address - Phone:301-600-1506
Practice Address - Fax:301-662-9079
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB69460Medicare UPIN
MS512I110029Medicare PIN
MS110220657Medicare PIN
MSP00629124Medicare PIN
MS0123910Medicaid
LA1136794Medicaid
MS110001460Medicare ID - Type Unspecified