Provider Demographics
NPI:1982708236
Name:MEDICAL SPECIALISTS OF FREDERICKSBURG INC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF FREDERICKSBURG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESSIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-371-1700
Mailing Address - Street 1:240 EXECUTIVE CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3107
Mailing Address - Country:US
Mailing Address - Phone:540-371-1700
Mailing Address - Fax:540-371-1793
Practice Address - Street 1:240 EXECUTIVE CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3107
Practice Address - Country:US
Practice Address - Phone:540-371-1700
Practice Address - Fax:540-371-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA025214OtherANTHEM BCBS
VA60661B6Medicaid
110011999OtherRAILROAD MEDICARE
VA60661B6Medicaid
VA0350310001Medicare NSC