Provider Demographics
NPI:1700883329
Name:FREKKO, TIBOR E (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBOR
Middle Name:E
Last Name:FREKKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:818 WEST DIAMOND AVENUE
Mailing Address - Street 2:STE 130
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-948-8780
Mailing Address - Fax:301-519-9093
Practice Address - Street 1:818 WEST DIAMOND AVENUE
Practice Address - Street 2:STE 130
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-948-8780
Practice Address - Fax:301-519-9093
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0003716207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212401900Medicaid
MD212401900Medicaid
FR174770Medicare ID - Type Unspecified