Individual provider Active NPI

Christian Joseph Frederickson, MD

  • Student in an Organized Health Care Education/Training Program
  • Jefferson, LA
National Provider Identifier
1124915202
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
347615 Issued in LA
Practice address
1401 Jefferson Hwy FL Center1
Jefferson, LA 70121-2426
Phone
(504) 842-3260
Fax
(504) 842-3193
NPI assigned
Jun 20, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 347615 LA Primary

Addresses

Primary practice location

1401 Jefferson Hwy FL Center1
Jefferson, LA 70121-2426

Mailing address

4206 S Galvez St
New Orleans, LA 70125-4524
Phone (301) 222-7889

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250707002478 LA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 5395259063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
347615LAMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1124915202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4206 S GALVEZ ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701254524",
            "telephone_number": "301-222-7889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 JEFFERSON HWY FL CENTER1",
            "city": "JEFFERSON",
            "state": "LA",
            "postal_code": "701212426",
            "telephone_number": "504-842-3260",
            "fax_number": "504-842-3193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "CHRISTIAN",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-20",
        "last_updated": "2025-06-20",
        "certification_date": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": "347615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, LA

Sources for this page

Verify at the official NPI Registry.