Provider Demographics
NPI:1316997570
Name:MAUTE, FREDERICK CARL (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CARL
Last Name:MAUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4001
Mailing Address - Country:US
Mailing Address - Phone:434-797-4620
Mailing Address - Fax:434-793-8992
Practice Address - Street 1:927 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4001
Practice Address - Country:US
Practice Address - Phone:434-797-4620
Practice Address - Fax:434-793-8992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039725207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6241026Medicaid
VA051066OtherANTHEM
B10010Medicare UPIN