Healthcare Provider Details

I. General information

NPI: 1265892558
Provider Name (Legal Business Name): CHRISTOPHER SEAN FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 HERCULES DR
COLCHESTER VT
05446-5993
US

IV. Provider business mailing address

593 HERCULES DR
COLCHESTER VT
05446-5993
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-5350
  • Fax: 802-338-9390
Mailing address:
  • Phone: 802-488-5350
  • Fax: 802-338-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042.0040567
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: