Nicholas Lorne Frederickson, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

MMD.88225 Issued in SC

Practice address

171 Ashley Ave
Charleston, SC 29425-0100

Phone

(843) 792-1414

NPI assigned

Jun 16, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1655337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1639809130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 ASHLEY AVE # MSC908",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294250100",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKSON",
        "first_name": "NICHOLAS",
        "middle_name": "LORNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-16",
        "last_updated": "2022-06-16",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "SC",
            "license": "MMD.88225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ukeisha Renee Frazier, NP
• Allison Beth Frederick, MD
• Kira Leilani Frederick, PHARMD
• Scott Frederick, MSW
• Denise B. Fredericks, P.T.
• Glenn E Freedman, MD
• John Richard Freedy, MD
• Michael Radford Freeling, MD
• Jennifer Lauren Freeman-Rose, FNP-C
• Hogan Bernard Freeman, D.M.D.

• Anatomic Pathology & Clinical Pathology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Anatomic Pathology & Clinical Pathology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.