Provider Demographics
NPI:1649356247
Name:SIRKIS, FREDRIC STEWART (MD)
Entity type:Individual
Prefix:
First Name:FREDRIC
Middle Name:STEWART
Last Name:SIRKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-296-7799
Mailing Address - Fax:410-307-1001
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 308
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-296-7799
Practice Address - Fax:410-307-1001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2623OtherELDERHEALTH
MI7516296OtherCIGNA HEALTHCARE
MD904AOtherCAREFIRST OF MARYLAND
MD353218OtherAETNA HMO/QPOS
MD772031900Medicaid
MD4295642OtherAETNA CHOICE PLANS
DCJ8510001OtherCAREFIRST OF NCA
MD2623OtherELDERHEALTH
MD772031900Medicaid
MD904AOtherCAREFIRST OF MARYLAND