Provider Demographics
NPI:1134282197
Name:FREDERICKSBURG OBGYN CENTER INC
Entity Type:Organization
Organization Name:FREDERICKSBURG OBGYN CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-371-6330
Mailing Address - Street 1:621 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4437
Mailing Address - Country:US
Mailing Address - Phone:540-371-6331
Mailing Address - Fax:540-373-4523
Practice Address - Street 1:621 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4437
Practice Address - Country:US
Practice Address - Phone:540-371-6331
Practice Address - Fax:540-373-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03053OtherGROUP NUMBER