Provider Demographics
NPI:1518023878
Name:FRYE, TINA W (DPM)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:W
Last Name:FRYE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-1130
Mailing Address - Country:US
Mailing Address - Phone:804-642-1417
Mailing Address - Fax:804-642-1009
Practice Address - Street 1:2900 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3429
Practice Address - Country:US
Practice Address - Phone:804-642-1417
Practice Address - Fax:804-642-1009
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001001213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009304584Medicaid
VA480000563Medicare ID - Type Unspecified
VA009304584Medicaid