Provider Demographics
NPI:1164827572
Name:FREDERICKSBURG PSYCHIATRY PLC
Entity Type:Organization
Organization Name:FREDERICKSBURG PSYCHIATRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-310-4822
Mailing Address - Street 1:1500 DIXON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-7231
Mailing Address - Country:US
Mailing Address - Phone:540-310-4822
Mailing Address - Fax:540-368-0618
Practice Address - Street 1:1500 DIXON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7231
Practice Address - Country:US
Practice Address - Phone:540-310-4822
Practice Address - Fax:540-368-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty