Provider Demographics
NPI:1679506042
Name:FREDNER, MARIAN S (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:S
Last Name:FREDNER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 BERKMAR DR
Mailing Address - Street 2:STE 2B
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1889
Mailing Address - Country:US
Mailing Address - Phone:434-975-4327
Mailing Address - Fax:434-293-4327
Practice Address - Street 1:3315 BERKMAR DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1491
Practice Address - Country:US
Practice Address - Phone:434-975-4327
Practice Address - Fax:434-293-4327
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101000805237700000X
VA2201000509231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659441608OtherGROUP NPI FOR PEDIATRIC ASSOCIATES OF CHARLOTTESVILLE
VA1679506042OtherNPI
VA157891OtherSOUTHERN HEALTH
VA700021883OtherCIGNA
VA4501317OtherUNITED HEALTH CARE
VA440529OtherANTHEM/BCBS