Individual
DR. FREDERICK PAUL VANDUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
119 C N MAIN STREET, GALENA, MD 21635
(410) 648-5150
(410) 648-5140
Mailing address
119 CN MAIN STREET, GALENA, MD 21635
(410) 648-5150
(410) 648-5140
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C20004063
DE
207Q00000X
Family Medicine Physician
Primary
H67200
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001067004
—
DE
01
—
038396
PRIORITY PARTNERS
MD
05
—
442259700
—
MD
01
—
521116591
INFORMED
MD
01
—
5391600
AETNA
MD
01
—
8177823
UNITED HEALTHCARE/MAMSI/OPT CHOICE
MD
Enumeration date
12/01/2005
Last updated
03/27/2012
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