Provider Demographics
NPI:1861744559
Name:FREDERICK KIDNEY CARE ASSOCIATES
Entity type:Organization
Organization Name:FREDERICK KIDNEY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-696-0012
Mailing Address - Street 1:405 W 7TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4505
Mailing Address - Country:US
Mailing Address - Phone:301-696-0012
Mailing Address - Fax:301-696-0016
Practice Address - Street 1:405 W 7TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4505
Practice Address - Country:US
Practice Address - Phone:301-696-0012
Practice Address - Fax:301-696-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1033305263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418519600Medicaid
MD418519600Medicaid