Provider Demographics
NPI:1669439808
Name:FREDERICK, MAUREEN M (PT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:M
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NEW BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2701
Mailing Address - Country:US
Mailing Address - Phone:215-348-2801
Mailing Address - Fax:215-677-3266
Practice Address - Street 1:126 S STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3524
Practice Address - Country:US
Practice Address - Phone:215-579-6991
Practice Address - Fax:215-579-9774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005508L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0116985000OtherPERSONAL CHOICE NUMBER
PA023229H6YMedicare ID - Type Unspecified