Provider Demographics
NPI:1184809949
Name:FREDERICK, ADAM RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:RANDALL
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:STE. 305
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-790-1103
Mailing Address - Fax:818-949-4981
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:STE. 305
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-1103
Practice Address - Fax:818-949-4981
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT6825146-1205207Q00000X
CAA109537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine