Individual
DAVID JONATHAN FREDERIKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
365 MONTAUK AVE, ROOM 4.512, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 444-5144
Mailing address
365 MONTAUK AVE, ROOM 4.512, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 444-5144
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
036811
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001368118
—
CT
Enumeration date
08/09/2006
Last updated
06/14/2013
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