MEDICARE: FREDERICK W PARKER III 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	207Q00000X	Family Medicine Physician	0101024081	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922008291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK W PARKER III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	703-368-3161
Fax Number	:	703-368-2498

Provider Business Practice Location Address
First Line	:	10322 BRISTOW CENTER DR
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-2201
Country	:	US
Telephone Number	:	571-284-4230
Fax Number	:	703-257-1495

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/21/2021

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