| Frederick Psychiatric Medicine | |
|
10001 Pebble Beach Ter Ijamsville MD 21754-9147 | |
| (301) 606-7785 | |
| (240) 310-1927 |
| Full Name | Frederick Psychiatric Medicine |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 10001 Pebble Beach Ter, Ijamsville, Maryland |
| Authorized Official Name and Position | Corvin Robinson (OWNER) |
| Authorized Official Contact | 3016067785 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Frederick Psychiatric Medicine 10001 Pebble Beach Ter Ijamsville MD 21754-9147 Ph: (301) 606-7785 | Frederick Psychiatric Medicine 10001 Pebble Beach Ter Ijamsville MD 21754-9147 Ph: (301) 606-7785 |
| NPI Number | 1619411121 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 12/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619411121 | NPI | - | NPPES |
| 60054 | Other | MD | AETNA |
| MDMCD | Medicaid | MD | |
| 00823 | Other | VALUE OPTIONS | |
| SKMDO | Medicaid | MD | |
| SB580 | Other | MD | BLUE CROSS/BLUE SHIELD |
| D0044857 | Other | MD | MEDICAL LICENSE |
| SX173 | Other | MD | BEACON HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | DOO44857 (Maryland) | Primary |
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