Provider Demographics
NPI:1629190905
Name:FREDERICKSEN, JUDITH SUBEDI (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:SUBEDI
Last Name:FREDERICKSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2717
Mailing Address - Country:US
Mailing Address - Phone:540-635-7991
Mailing Address - Fax:540-636-2516
Practice Address - Street 1:625 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2717
Practice Address - Country:US
Practice Address - Phone:540-635-7991
Practice Address - Fax:540-636-2516
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057099207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69077Medicare UPIN