Provider Demographics
NPI:1922132281
Name:FREDERICK ENT GROUP P.A.
Entity type:Organization
Organization Name:FREDERICK ENT GROUP P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-698-2440
Mailing Address - Street 1:82 THOMAS JOHNSON CT.
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4348
Mailing Address - Country:US
Mailing Address - Phone:301-698-2440
Mailing Address - Fax:301-846-0892
Practice Address - Street 1:82 THOMAS JOHNSON CT.
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-698-2440
Practice Address - Fax:301-846-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE59093Medicare UPIN
MDH28757Medicare UPIN