Provider Demographics
NPI:1750109435
Name:FREDERICK METABOLIC AND PRIMARY CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:FREDERICK METABOLIC AND PRIMARY CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAFRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-650-2806
Mailing Address - Street 1:184 THOMAS JOHNSON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4562
Mailing Address - Country:US
Mailing Address - Phone:240-949-7519
Mailing Address - Fax:240-450-2764
Practice Address - Street 1:184 THOMAS JOHNSON DR STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4562
Practice Address - Country:US
Practice Address - Phone:516-650-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty