Active NPI
Clement N Tedom
- Driver
- Fredericksburg, VA
National Provider Identifier
1033809694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- B66050191
- Practice address
- 1039 Bakersfield LN
Fredericksburg, VA 22401-2783 - Phone
- (240) 577-0909
- NPI assigned
- May 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | B66050191 | VA | Primary |
Addresses
Primary practice location
1039 Bakersfield LN
Fredericksburg, VA 22401-2783
Mailing address
1039 Bakersfield LN
Fredericksburg, VA 22401-2783
Phone (240) 577-0909
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B66050191 | VA | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1033809694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1039 BAKERSFIELD LN",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224012783",
"telephone_number": "240-577-0909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1039 BAKERSFIELD LN",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224012783",
"telephone_number": "240-577-0909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEDOM",
"first_name": "CLEMENT",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "VA",
"license": "B66050191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.