1770147746 NPI number — DEVON CLEMONS FREUDENBERGER MD

Table of content: DEVON CLEMONS FREUDENBERGER MD (NPI 1770147746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770147746 NPI number — DEVON CLEMONS FREUDENBERGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREUDENBERGER
Provider First Name:
DEVON
Provider Middle Name:
CLEMONS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770147746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VCUHS GMEA
Provider Second Line Business Mailing Address:
BOX 980257
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23298-0257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-828-9735
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VCUHS DEPT OF SURGERY RESIDENCY, 980135
Provider Second Line Business Practice Location Address:
1250 E MARSHALL STREET
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298-0135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-628-9789
Provider Business Practice Location Address Fax Number:
804-828-5595
Provider Enumeration Date:
04/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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