Individual
WAYNE AI FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2041 GEORGIA AVE NW, STE 4000, WASHINGTON, DC 20060-0001
(202) 865-6237
(860) 679-1390
Mailing address
6138 31ST PL NW, WASHINGTON, DC 20015-1502
(202) 865-6237
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
041334
CT
208600000X
Surgery Physician
MD30905
DC
2086X0206X
Surgical Oncology Physician
Primary
MD30905
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010266505
—
VA
05
—
037841900
—
DC
05
—
410159600
—
MD
Enumeration date
06/22/2005
Last updated
09/23/2019
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