Provider Demographics
NPI:1508834532
Name:QUARLES, FREDERICK N (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:N
Last Name:QUARLES
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 1:3384 VILLAGE SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1360
Mailing Address - Country:US
Mailing Address - Phone:757-619-0392
Mailing Address - Fax:
Practice Address - Street 1:77 NEALY AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2040
Practice Address - Country:US
Practice Address - Phone:757-225-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038009207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA209918OtherANTHEM
VA005985005Medicaid
VA15790OtherOPTIMA
VA209920OtherANTHEM
VA070000164Medicare PIN
VA15790OtherOPTIMA
VAB08392Medicare UPIN