Active NPI
Ted Marcel Frederic, DO
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1760167357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OT022778
- Practice address
- 3401 N Broad St Ste 810
Philadelphia, PA 19140-5103 - Phone
- (215) 707-4085
- NPI assigned
- Jun 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OT022778 | PA | Primary |
Addresses
Primary practice location
3401 N Broad St Ste 810
Philadelphia, PA 19140-5103
Mailing address
3401 N Broad St Ste 810
Philadelphia, PA 19140-5103
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT022778 | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1760167357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 N BROAD ST STE 810",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 N BROAD ST STE 810",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191405103",
"telephone_number": "215-707-4085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERIC",
"first_name": "TED",
"middle_name": "MARCEL",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-20",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OT022778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.