Active NPI
Fredia Stovall Wadley
- Public Health or Welfare Agency
- Easton, MD
National Provider Identifier
1356793863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health or Welfare Agency
- Practice address
- 100 S Hanson St
Easton, MD 21601-2920 - Phone
- (410) 819-5606
- Fax
- (410) 819-4703
- NPI assigned
- Jul 8, 2016
- Last updated
- Jul 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0066574 | MD | |
| Public Health or Welfare Agency | 251K00000X | Primary |
Addresses
Primary practice location
100 S Hanson St
Easton, MD 21601-2920
Mailing address
100 S Hanson St
Easton, MD 21601-2920
Phone (410) 819-5606
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M87082 | Other | MD | STATE OF MARYLAND CDS NUMBER |
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 |
|---|---|---|---|
| D0066574 | MD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467936000000",
"number": "1356793863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S HANSON ST",
"city": "EASTON",
"state": "MD",
"postal_code": "216012920",
"telephone_number": "410-819-5606",
"fax_number": "410-819-4703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S HANSON ST",
"city": "EASTON",
"state": "MD",
"postal_code": "216012920",
"telephone_number": "410-819-5606",
"fax_number": "410-819-4703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADLEY",
"first_name": "FREDIA",
"middle_name": "STOVALL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-08",
"last_updated": "2016-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0066574",
"primary": false
},
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MARYLAND CDS NUMBER",
"identifier": "M87082",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Easton, MD
- Jennette Lee Vonbargen, PSY.D
- Michelle Elise Voss, RN
- W James Downs Jr PT PA (Tidewater Electromyography)
- Farah Waddell, PT, DPT
- Justin G Wade, MD
- Lucinda Wakefield, PT
- Wal-Mart Stores East LP (Walmart Pharmacy 10-1715)
- Walgreen Co (Walgreens #09967)
- Walgreen Co. (Walgreens #9967)
- Lauren Leeanne Walker, CPNP-PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.