Individual
FREIDRICH DATU ANSELMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3025 HAMAKER CT STE 340, FAIRFAX, VA 22031-2237
(703) 849-8036
(703) 204-3448
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101279799
VA
Other
Enumeration date
03/30/2020
Last updated
01/13/2025
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