Provider Demographics
NPI:1881610517
Name:ENOS, FREDRICK E (PA-C)
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:E
Last Name:ENOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BRANCHVIEW DR. NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-403-9050
Mailing Address - Fax:704-403-9051
Practice Address - Street 1:310 S STRATFORD RD STE 120
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1820
Practice Address - Country:US
Practice Address - Phone:336-714-5399
Practice Address - Fax:336-725-4799
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101157Medicaid
NC2750183MMedicare PIN
NC2750183GMedicare PIN
NC2750183DMedicare PIN
NC2750183HMedicare PIN
NC2750183PMedicare PIN
NC2750183SMedicare PIN
NC2750183UMedicare PIN
NC2750183VMedicare PIN
NC2750183KMedicare PIN
NC2750183EMedicare PIN
NC2750183RMedicare PIN
NC2750183TMedicare PIN
NC2750183FMedicare PIN
NC2750183JMedicare PIN
NC2750183WMedicare PIN
NC2750183LMedicare PIN
NC2750183NMedicare PIN