Provider Demographics
NPI:1093034944
Name:FREDERICK, DEBRALEE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRALEE
Middle Name:B
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 GALLOWAY ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6312
Mailing Address - Country:US
Mailing Address - Phone:202-350-1546
Mailing Address - Fax:202-983-5497
Practice Address - Street 1:430 GALLOWAY ST NE STE A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6312
Practice Address - Country:US
Practice Address - Phone:202-350-1546
Practice Address - Fax:202-983-5497
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078301208M00000X
DCMD042272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC085010500Medicaid
MD124113300Medicaid