Individual
JOHN RANDALL FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1650 HUNTINGDON PIKE, SUITE 154, MEADOWBROOK, PA 19046-8004
(215) 938-3145
(215) 938-3144
Mailing address
1650 HUNTINGDON PIKE, SUITE 154, MEADOWBROOK, PA 19046-8004
(215) 938-3145
(215) 938-3144
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M.D.032063E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1886916-03
—
PA
Enumeration date
11/10/2005
Last updated
01/05/2016
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