Provider Demographics
NPI:1316167208
Name:FREDERICK COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:FREDERICK COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKMYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH
Authorized Official - Phone:301-600-2509
Mailing Address - Street 1:350 MONTEVUE LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8214
Mailing Address - Country:US
Mailing Address - Phone:301-600-1029
Mailing Address - Fax:
Practice Address - Street 1:300 SCHOLLS LN # B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6380
Practice Address - Country:US
Practice Address - Phone:301-600-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14054251S00000X
MD14053251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410767500Medicaid