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1962408252

NPI Code Detail

MEDICARE: WAYNE AI FREDERICK MD

MEDICARE: WAYNE AI FREDERICK MD

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	2086X0206X	Surgical Oncology Physician	MD30905	DC
2	208600000X	Surgery Physician	MD30905	DC
3	208600000X	Surgery Physician	041334	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962408252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE AI FREDERICK MD

Provider Business Mailing Address
First Line	:	6138 31ST PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20015-1502
Country	:	US
Telephone Number	:	202-865-6237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 GEORGIA AVE NW
Second Line	:	STE 4000
City	:	WASHINGTON
State	:	DC
Zip	:	20060-0001
Country	:	US
Telephone Number	:	202-865-6237
Fax Number	:	860-679-1390

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/23/2019

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Directions to “ WAYNE AI FREDERICK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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