Individual
DR. NATHAN P FREDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-8015
(843) 347-8017
Mailing address
PO BOX 829, CONWAY, SC 29528-0829
(843) 347-8015
(843) 347-8017
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
637
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020051649
MEDICARE RAILROAD
—
05
—
0361220182
—
IL
01
—
P00679662
RAILROAD MCARE
—
01
—
P00936457
RRMCARE THRU CESIISC (GES)
IL
05
—
T00391
—
SC
Enumeration date
07/07/2006
Last updated
08/17/2011
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