MEDICARE: KRISTIN FREDERICK

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	208000000X	Pediatrics Physician	MD051557L	PA

General Provider Information

NPI Number	:	1851394423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN FREDERICK

Provider Business Mailing Address
First Line	:	103 BRADFORD RD STE 200
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-6910
Country	:	US
Telephone Number	:	724-933-1100
Fax Number	:	724-933-1160

Provider Business Practice Location Address
First Line	:	1600 PACIFIC AVE
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2138
Country	:	US
Telephone Number	:	724-224-3900
Fax Number	:	724-224-9010

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/31/2022

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Directions to “ KRISTIN FREDERICK ” Practice Location

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