Organization
PRIMEDOC OF FREDERICK PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT REYNOLDS MD (PRESIDENT)
(828) 210-3260
Entity
Organization
Contact information
Practice address
400 W SEVENTH ST, FREDERICK, MD 21701-4506
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 601360, CHARLOTTE, NC 28260-1360
(843) 237-3378
(843) 237-5073
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136915
BCBS
VA
05
—
404823700
—
MD
01
—
633APR
BLUE SHIELD STATE
MD
01
—
DB5153
RAILROAD MEDICARE
MD
01
—
J585
BLUE SHIELD FEDERAL
MD
Enumeration date
04/24/2006
Last updated
03/16/2009
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