Individual
FREDERICK PLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3111
(800) 536-8431
Mailing address
PO BOX 75567, BALTIMORE, MD 21275-5567
(888) 898-3291
(800) 536-8431
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101231149
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5859956
—
VA
Enumeration date
05/15/2006
Last updated
07/17/2007
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