Provider Demographics
NPI:1457311839
Name:VONFRICKEN, MANFRED A (MD)
Entity Type:Individual
Prefix:DR
First Name:MANFRED
Middle Name:A
Last Name:VONFRICKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7501 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:301-474-7182
Practice Address - Street 1:8505 ARLINGTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4621
Practice Address - Country:US
Practice Address - Phone:703-698-9335
Practice Address - Fax:703-207-0038
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0021492207W00000X
VA0101032050207W00000X
DCMD12609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006392423Medicaid
VA006306837Medicaid
MD477441800Medicaid
DC024861600Medicaid
B05612Medicare UPIN
VA006392423Medicaid