Healthcare Provider Details

I. General information

NPI: 1982708236
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF FREDERICKSBURG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 EXECUTIVE CENTER PARKWAY
FREDERICKSBURG VA
22401-3107
US

IV. Provider business mailing address

240 EXECUTIVE CENTER PARKWAY
FREDERICKSBURG VA
22401-3107
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-1700
  • Fax: 540-371-1793
Mailing address:
  • Phone: 540-371-1700
  • Fax: 540-371-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEROY J ESSIG
Title or Position: PRESIDENT
Credential: MD
Phone: 540-371-1700