Frederic Charles Hendrickson, DO
Individual provider Active NPI Family Medicine Physician · Paulding, OH
NPI 1528056629 · NPPES record last updated Mar 3, 2010
Key facts
- NPI
- 1528056629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 34-00-5455 (OH)
- Practice address
- 11550 State Route 500
Paulding, OH 45879-9173 - Phone
- (419) 399-2630
- Fax
- (419) 782-8853
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34-00-5455 | OH | Yes |
Addresses
Primary practice location
11550 State Route 500
Paulding, OH 45879-9173
Mailing address
11550 State Route 500
Paulding, OH 45879-9173
Phone (419) 399-2630
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0853170 | Medicaid | OH |
Other providers in Paulding, OH
- Virginia Halachanova
- Alexis Leann Hanicq
- Paul William Harr
- Healthcare Ventures of Ohio LLC
- Healthcare Ventures of Ohio LLC
- Barbara Hoersten
- Nigel Hogan
- Tawny Hohenberger
- Hughes Enterprises Inc
- Heather Nicole Jacobs
All providers in Paulding, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.