Healthcare Provider Details

I. General information

NPI: 1295427946
Provider Name (Legal Business Name): LAQUANDA FREDERICKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 27TH ST
LUMBERTON NC
28358-3018
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-7551
  • Fax:
Mailing address:
  • Phone: 910-735-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME177997
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME177997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: