Frederick Family Medical Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D0076463 Issued in MD

Legal business name

FREDERICK FAMILY MEDICAL CLINIC

Practice address

1709 Rosemont Ave
Frederick, MD 21702-4135

Phone

(301) 624-5999

Fax

(301) 624-5997

NPI assigned

Apr 17, 2018

Last updated

Apr 7, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Innocent Monya-Tambi, MDNPI 1386829679

Title

Owner

Phone

(301) 624-5999

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Innocent Monya-Tambi, MD

  • Internal Medicine Physician
  • Frederick, MD
  • NPI 1386829679
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1821585621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 ROSEMONT AVE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024135",
            "telephone_number": "301-624-5999",
            "fax_number": "301-625-5997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 ROSEMONT AVE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024135",
            "telephone_number": "301-624-5999",
            "fax_number": "301-624-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-17",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "MONYA-TAMBI",
        "authorized_official_first_name": "INNOCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-624-5999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0076463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Frederick, MD
• Providers in Frederick, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.