# MEDIC 1

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164456398
- **Authorized official:** MS. AIMEE VANESSA HEGADORN (PRACTICE MANAGER)
- **Authorized official phone:** (540) 371-1664

## Contact information

- **Practice address:** 20 105 PLANTATION DR, FREDERICKSBURG, VA 22406
- **Practice address phone:** (540) 368-2020
- **Practice address fax:** (540) 368-2030
- **Mailing address:** 3429 JEFFERSON DAVIS HWY, FREDERICKSBURG, VA 22408
- **Mailing address phone:** (540) 371-1664
- **Mailing address fax:** (540) 371-2411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0102201074 | VA | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 08/22/2020