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Organization

FREDERICK ANESTHESIA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DAVID LEE JORDAN M.D. (PRESIDENT)
(301) 829-7683
Entity
Organization

Contact information

Practice address
85 THOMAS JOHNSON CT, SUITE E, FREDERICK, MD 21702-4331
(301) 668-1600
(301) 829-7694
Mailing address
602 CENTER ST, SUITE 107, MOUNT AIRY, MD 21771-7420
(301) 829-7683
(301) 829-7694

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
230BFR
CAREFIRST PAR PROVIDER #
MD
01
CA7369
RR MEDICARE
MD
01
DC6641
RAILROAD PAR GROUP #
DC
01
K297
CAREFIRST PAR PROVIDER #
DC
Enumeration date
08/18/2006
Last updated
10/16/2007
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