Provider Demographics
NPI:1275561870
Name:FRANCIS, FREDISIA CLAVENDA (MD)
Entity type:Individual
Prefix:DR
First Name:FREDISIA
Middle Name:CLAVENDA
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FREDISIA
Other - Middle Name:
Other - Last Name:BRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 C ST
Mailing Address - Street 2:STE D
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4152
Mailing Address - Country:US
Mailing Address - Phone:301-478-8080
Mailing Address - Fax:301-478-8081
Practice Address - Street 1:6510 KENILWORTH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1339
Practice Address - Country:US
Practice Address - Phone:301-486-7850
Practice Address - Fax:301-486-7581
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI48247Medicare UPIN
018715M58Medicare PIN
DC018715M58Medicare PIN