Provider Demographics
NPI:1861494411
Name:DUDENHOEFER, FREDERICK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN
Last Name:DUDENHOEFER
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 1:3413 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2678
Mailing Address - Country:US
Mailing Address - Phone:814-451-8043
Mailing Address - Fax:814-868-8561
Practice Address - Street 1:3413 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2678
Practice Address - Country:US
Practice Address - Phone:814-451-8043
Practice Address - Fax:814-868-8561
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017588E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030004814Medicare PIN
PA139781Medicare PIN
PA368257OtherHEALTHAMERICA/COVENTRY
PA207382OtherUPMC
000139781OtherHIGHMARK BLUE SHIELD/CROS
00025216901OtherUNIVERA