Healthcare Provider Details

I. General information

NPI: 1154225837
Provider Name (Legal Business Name): FREDERICK SCOTT WITHROW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHERRY DR APT A
DAYTON OH
45405-3314
US

IV. Provider business mailing address

111 CHERRY DR APT A
DAYTON OH
45405-3314
US

V. Phone/Fax

Practice location:
  • Phone: 326-239-7001
  • Fax:
Mailing address:
  • Phone: 326-239-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: