Provider Demographics
NPI:1114984358
Name:FRAIFELD, EDUARDO MAURICIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:MAURICIO
Last Name:FRAIFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRIDGE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1222
Mailing Address - Country:US
Mailing Address - Phone:434-793-4711
Mailing Address - Fax:434-797-2514
Practice Address - Street 1:109 BRIDGE ST STE 300
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1222
Practice Address - Country:US
Practice Address - Phone:347-934-7114
Practice Address - Fax:434-797-2514
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055618207L00000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA366425OtherANTHEM BCBS VA
VA5708702Medicaid
NC890557QMedicaid
VAP00814694OtherRR MEDICARE VA
NC0557QOtherBCBS
VAP00814694OtherRR MEDICARE VA