Provider Demographics
NPI:1801391032
Name:FREDERICK, MEAGHAN KATHLENE (MD)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:KATHLENE
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:KATHLENE
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 ALBERT SABIN WAY, MSB 1654, ML 0769
Mailing Address - Street 2:UC EMERGENCY MEDICINE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0769
Mailing Address - Country:US
Mailing Address - Phone:513-558-5281
Mailing Address - Fax:513-558-5791
Practice Address - Street 1:234 GOODMAN STREET
Practice Address - Street 2:CENTER FOR EMERGENCY CARE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-0796
Practice Address - Country:US
Practice Address - Phone:513-558-5281
Practice Address - Fax:513-558-5791
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.142655207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program