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General NPI Number Information
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NPI Number | 1487093670
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Entity Type | Organization
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Legal Business Name | FAMILY CARE OF FREDERICKSBURG, PLC
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 2216 PRINCESS ANNE ST SUITE 106
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3300
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Country | US
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Telephone | 540-840-9815
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Fax | 540-371-3748
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Provider Business Mailing Address
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Address Line | 2216 PRINCESS ANNE ST SUITE 106
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3300
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Country | US
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Telephone | 540-840-9815
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Fax | 540-371-3748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL G. MULDOON
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Credential | MD
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Telephone | 540-840-9815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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