MEDICARE: DR. CARRIE L. FREDERICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	012048	ME

General Provider Information

NPI Number	:	1497741706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE L. FREDERICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 830
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04212-0830
Country	:	US
Telephone Number	:	207-786-8816
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 ASPEN CREST RD
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-3823
Country	:	US
Telephone Number	:	207-829-6536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

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