NPIMap

Individual provider Active NPI

Fredric E Wondisford, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Baltimore, MD
National Provider Identifier
1992885636
Registry record updated Mar 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
D63464 Issued in MD
Practice address
600 N Wolfe St
Park 211
Baltimore, MD 21287-0005
Phone
(410) 502-5761
NPI assigned
Oct 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 75944 MA
Endocrinology, Diabetes & Metabolism Physician 207RE0101X D63464 MD Primary
Internal Medicine Physician 207R00000X D63464 MD

Addresses

Primary practice location

600 N Wolfe St
Park 211
Baltimore, MD 21287-0005

Mailing address

600 N Wolfe St
Baltimore, MD 21287-0005

Other identifiers 1

IdentifierTypeStateIssuer
011613100MedicaidMD

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 Medicine

State licenses

LicenseStateTypeSpecialty
75944MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers Health-RWJ Scleroderma Program PastSince Sep 26, 2017 Accepting new patients
Rutgers Health-RWJ Scleroderma Program PastSince Sep 26, 2017 Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty PastSince Sep 26, 2017 Accepting new patients
Rutgers Health-RWJ Scleroderma Program PastSince Sep 26, 2017 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: fwondisford17969@epicdirect.rwjbh.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1992885636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N WOLFE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N WOLFE ST",
            "address_2": "PARK 211",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870005",
            "telephone_number": "410-502-5761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDISFORD",
        "first_name": "FREDRIC",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "75944",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MD",
            "license": "D63464",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D63464",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011613100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.