Individual
DR. CAROLYN ANNE FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 HOWARD AVE LOWR LEVEL, NEW HAVEN, CT 06519-1369
(203) 785-4085
Mailing address
58 MADISON AVE, MADISON, CT 06443-3106
(203) 807-0401
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
63939
CT
2084N0400X
Neurology Physician
A119001
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/08/2010
Last updated
08/11/2019
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