Healthcare Provider Details

I. General information

NPI: 1699746677
Provider Name (Legal Business Name): FREDERICK SWARTZENDRUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BOXWOOD LN
PEARISBURG VA
24134-1168
US

IV. Provider business mailing address

430 BOXWOOD LN
PEARISBURG VA
24134-1168
US

V. Phone/Fax

Practice location:
  • Phone: 540-921-2158
  • Fax: 540-921-2915
Mailing address:
  • Phone: 540-921-2158
  • Fax: 540-921-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101048289
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29680
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101048289
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: