Provider Demographics
NPI:1447231519
Name:VERMEULEN, FRED DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:DONALD
Last Name:VERMEULEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 E SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2408
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:704-375-8623
Practice Address - Street 1:1420 E SEVENTH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2408
Practice Address - Country:US
Practice Address - Phone:704-375-0100
Practice Address - Fax:704-375-8623
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26065174400000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8984992Medicaid
211172Medicare ID - Type Unspecified
NC8984992Medicaid