Provider Demographics
NPI:1144426891
Name:SHENANDOAH MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SHENANDOAH MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-635-7991
Mailing Address - Street 1:625 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2717
Mailing Address - Country:US
Mailing Address - Phone:540-635-7991
Mailing Address - Fax:
Practice Address - Street 1:625 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2717
Practice Address - Country:US
Practice Address - Phone:540-635-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty