| Mason-dixon Mobile Medicine | |
|
723 N Market St Frederick MD 21701-5232 | |
| (240) 397-6723 | |
| (833) 992-0865 |
| Full Name | Mason-dixon Mobile Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 723 N Market St, Frederick, Maryland |
| Authorized Official Name and Position | Douglas H. Brown (PRIMARY MEMBER) |
| Authorized Official Contact | 2403976723 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mason-dixon Mobile Medicine 723 N Market St Frederick MD 21701-5232 Ph: (240) 397-6723 | Mason-dixon Mobile Medicine 723 N Market St Frederick MD 21701-5232 Ph: (240) 397-6723 |
| NPI Number | 1073142147 |
|---|---|
| Provider Enumeration Date | 04/02/2020 |
| Last Update Date | 01/11/2022 |
| Certification Date | 01/11/2022 |
| Medicare PECOS PAC ID | 3476982901 |
|---|---|
| Medicare Enrollment ID | O20200406000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073142147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Douglas H Brown |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1467638502 PECOS PAC ID: 8628128253 Enrollment ID: I20090602000587 |
| Provider Name | Joseph E Asuncion |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225009400 PECOS PAC ID: 1355480336 Enrollment ID: I20091204000112 |
| Provider Name | Randyl Gessel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124285184 PECOS PAC ID: 7113073578 Enrollment ID: I20150304000733 |
| Provider Name | Mary Mcdonald |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1356447692 PECOS PAC ID: 2961474135 Enrollment ID: I20230501001127 |
| Provider Name | Ruby Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720853286 PECOS PAC ID: 5092164673 Enrollment ID: I20231207002047 |
| Provider Name | Brandy Cloud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629382874 PECOS PAC ID: 2567771603 Enrollment ID: I20250122000443 |
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