Provider Demographics
NPI:1497933063
Name:FREUNDEL, ROSEANN J (DO)
Entity Type:Individual
Prefix:
First Name:ROSEANN
Middle Name:J
Last Name:FREUNDEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 15TH ST NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1627
Mailing Address - Country:US
Mailing Address - Phone:276-679-1623
Mailing Address - Fax:276-679-6811
Practice Address - Street 1:102 15TH ST NW
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1627
Practice Address - Country:US
Practice Address - Phone:276-679-1623
Practice Address - Fax:276-679-6811
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011243207V00000X
MEDO2699207VX0000X
MDH91026207V00000X
VA0102202500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497933063Medicaid
P00920877OtherRR MEDICARE
KY7100087150Medicaid
VA1497933063Medicaid
VA021266N56Medicare PIN
VAC10456Medicare UPIN