Provider Demographics
NPI:1073508321
Name:STRUTHERS, FREDERICK R (DO)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:STRUTHERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 YORK RD
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929
Mailing Address - Country:US
Mailing Address - Phone:215-343-8410
Mailing Address - Fax:215-491-9744
Practice Address - Street 1:2244 YORK RD
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929
Practice Address - Country:US
Practice Address - Phone:215-343-8410
Practice Address - Fax:215-491-9744
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003741L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010521250002Medicaid
PAST113778Medicare ID - Type Unspecified
PA0010521250002Medicaid