Healthcare Provider Details

I. General information

NPI: 1447384193
Provider Name (Legal Business Name): FREDERICK RHODE STODDARD II MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 MONTGOMERY AVE STE 207
NARBERTH PA
19072-1946
US

IV. Provider business mailing address

7339 HILL RD
PHILADELPHIA PA
19128-1411
US

V. Phone/Fax

Practice location:
  • Phone: 610-831-4569
  • Fax: 215-714-6977
Mailing address:
  • Phone: 215-292-4007
  • Fax: 215-487-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD425876
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberMD425876
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD425876
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD425876
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD425876
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: