# LAKESIDE MED, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mason-Dixon Mobile Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073142147
- **Authorized official:** DOUGLAS H. BROWN PA-C (PRIMARY MEMBER)
- **Authorized official phone:** (240) 397-6723

## Contact information

- **Practice address:** 723 N MARKET ST, FREDERICK, MD 21701-5232
- **Practice address phone:** (240) 397-6723
- **Practice address fax:** (833) 992-0865
- **Mailing address:** 723 N MARKET ST, FREDERICK, MD 21701-5232
- **Mailing address phone:** (240) 397-6723
- **Mailing address fax:** (833) 992-0865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2020
- **Last updated:** 01/11/2022