Provider Demographics
NPI:1427196740
Name:CORDER, FREDERICK JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JEROME
Last Name:CORDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2325
Mailing Address - Country:US
Mailing Address - Phone:301-446-7294
Mailing Address - Fax:
Practice Address - Street 1:3715 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1435
Practice Address - Country:US
Practice Address - Phone:301-887-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD168581300Medicaid
5217055205OtherFIN