Basic Information
| Provider Information | |||||||||
| NPI: | 1669439808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREDERICK | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 NEW BRITAIN RD | ||||||||
| Address2: | |||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189012701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153482801 | ||||||||
| FaxNumber: | 2156773266 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 S STATE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155796991 | ||||||||
| FaxNumber: | 2155799774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT005508L | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0116985000 | 01 | PA | PERSONAL CHOICE NUMBER | OTHER |