Individual
DR. MICHAEL ROY FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 MAIN ST, DANVILLE, VA 24541-1816
(434) 792-1433
(434) 797-2807
Mailing address
1040 MAIN ST, P.O. BOX 1360, DANVILLE, VA 24541-1816
(434) 792-1433
(434) 797-2807
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101233036
VA
207RN0300X
Nephrology Physician
200300471
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010131669
—
VA
01
—
171782
ANTHEM
VA
01
—
384373
MAMSI
—
01
—
7433254
CIGNA
—
05
—
89065HO
—
NC
Enumeration date
04/18/2006
Last updated
06/03/2015
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