Individual
ROBERT WINSTON FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 EVERGREEN DR STE 201, GLEN MILLS, PA 19342-1053
(267) 339-3558
(267) 339-3763
Mailing address
833 CHESTNUT ST STE 520, PHILADELPHIA, PA 19107-4430
(800) 321-9999
(267) 339-3761
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD068498L
PA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
25MA06942500
NJ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
73829
MA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD068498L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0440582000
IBC
NJ
01
—
0819217000
IBC
PA
01
—
2170578
AETNA
PA
01
—
2378262
AETNA
NJ
01
—
2781249
CIGNA
—
Enumeration date
06/01/2006
Last updated
10/07/2024
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