Provider Demographics
NPI:1306221981
Name:NORFOLK GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:NORFOLK GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-623-3700
Mailing Address - Street 1:31 PINE ST
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1642
Mailing Address - Country:US
Mailing Address - Phone:508-623-3700
Mailing Address - Fax:508-623-3701
Practice Address - Street 1:31 PINE ST
Practice Address - Street 2:SUITE # 300
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1642
Practice Address - Country:US
Practice Address - Phone:508-623-3700
Practice Address - Fax:508-623-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty