Individual
DR. FREDERICK IVAN ENDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
121 S MARKET ST, PETERSBURG, VA 23803-4217
(804) 733-8771
(804) 733-1017
Mailing address
121 S MARKET ST, PETERSBURG, VA 23803-4217
(804) 733-8771
(804) 733-1017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
BC83897
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005861861
—
VA
01
—
250896
ANTHEM BLUE CROSS
VA
Enumeration date
09/22/2006
Last updated
04/26/2010
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