MEDICARE: DR. DAVID EUGENE FREDERICK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	732	WV

General Provider Information

NPI Number	:	1205824893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID EUGENE FREDERICK PH.D.

Provider Business Mailing Address
First Line	:	1218 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2234
Country	:	US
Telephone Number	:	304-525-9959
Fax Number	:	304-525-0277

Provider Business Practice Location Address
First Line	:	1218 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2234
Country	:	US
Telephone Number	:	304-525-9959
Fax Number	:	304-525-0277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2005
Last Update Date	:	07/21/2022

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