Provider Demographics
NPI:1376783092
Name:FREDERICH, ROBERT CHARLES JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:FREDERICH
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:CHARLES
Other - Last Name:FREDERICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:16 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2709
Mailing Address - Country:US
Mailing Address - Phone:609-737-4402
Mailing Address - Fax:
Practice Address - Street 1:1030 S BROADWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2681
Practice Address - Country:US
Practice Address - Phone:859-257-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32851207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism