Healthcare Provider Details

I. General information

NPI: 1992784847
Provider Name (Legal Business Name): FREDERICK U VORWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DAYS INN DR
MOORESVILLE NC
28117-6323
US

IV. Provider business mailing address

650 SIGNAL HILL DRIVE EXT PO BOX 1845
STATESVILLE NC
28625-4353
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-9111
  • Fax: 704-663-4504
Mailing address:
  • Phone: 704-873-4277
  • Fax: 704-873-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9500264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: