Rosier Davis Dedwylder, MD
Individual provider Active NPI Family Medicine Physician · King George, VA
NPI 1871567073 · NPPES record last updated Feb 4, 2013
Key facts
- NPI
- 1871567073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0101035907 (VA)
- Practice address
- 16463 Dahlgren Rd
King George, VA 22485-5810 - Phone
- (540) 644-9505
- Fax
- (540) 644-9508
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041214000178 | VA | Practitioner - Family Practice | 3678530474 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| King George Medical Center LTD | Family Medicine | Past |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Medidoctors Primary Care LLC | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101035907 | VA | Yes |
Addresses
Primary practice location
16463 Dahlgren Rd
King George, VA 22485-5810
Mailing address
PO Box 1460
Fredericksburg, VA 22402-1460
Phone (540) 786-2100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871567073 | Other | VA | CIGNA |
| 1871567073 | Medicaid | VA |
Other providers in King George, VA
- Dahlgren Chiropractic Clinic, Inc
- Davis Cab of Colonial Beach
- Sarah H Davis
- Taylor Davis
- Roosevelt Dean Jr.
- Dental Professionals of Virginia, P.C.
- Rushvi Shailesh Desai
- Amy Hargrave Dickerson
- Linda Wiley Dicola
- Dominion Medical Center, LLC
All providers in King George, VA · Family Medicine Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.