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General NPI Number Information
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NPI Number | 1134282197
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG OBGYN CENTER INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 621 JEFFERSON DAVIS HWY SUITE 201
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4437
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Country | US
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Telephone | 540-371-6331
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Fax | 540-373-4523
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Provider Business Mailing Address
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Address Line | 621 JEFFERSON DAVIS HWY SUITE 201
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4437
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Country | US
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Telephone | 540-371-6331
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Fax | 540-373-4523
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. C EDWARD ROYSTER
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Credential | MD
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Telephone | 540-371-6330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | VA
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