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Organization
PROVIDENCE MEDICAL LLC
Active
Organization
PROVIDENCE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW DAUGHERTY (CEO)
(347) 571-1312
Entity
Organization
Contact information
Practice address
150 RIVERSIDE PKWY STE 115 PMB 5560, FREDERICKSBURG, VA 22406-1094
(347) 571-1312
Mailing address
150 RIVERSIDE PKWY STE 115, FREDERICKSBURG, VA 22406-1094
(347) 571-1312
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/08/2026
Last updated
01/14/2026
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