Provider Demographics
NPI:1447758198
Name:NOELIZAIRE, FRED
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:NOELIZAIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VIARS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2151
Mailing Address - Country:US
Mailing Address - Phone:434-941-7625
Mailing Address - Fax:
Practice Address - Street 1:109 VIARS RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2151
Practice Address - Country:US
Practice Address - Phone:434-941-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle