Provider Demographics
NPI:1922016278
Name:FREDERICK QUARLES
Entity Type:Organization
Organization Name:FREDERICK QUARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:QUARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-490-6637
Mailing Address - Street 1:4164 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1762
Mailing Address - Country:US
Mailing Address - Phone:757-490-6637
Mailing Address - Fax:757-490-6636
Practice Address - Street 1:4164 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1762
Practice Address - Country:US
Practice Address - Phone:757-490-6637
Practice Address - Fax:757-490-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508834532OtherDR FEDERICK QUARLES/NPI
VA1508834532OtherDR FEDERICK QUARLES/NPI