Provider Demographics
NPI:1336175629
Name:GERIATRIC CONSULTANTS OF FREDERICKSBURG, LLC
Entity type:Organization
Organization Name:GERIATRIC CONSULTANTS OF FREDERICKSBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WAYLAND
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-786-8351
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-0845
Mailing Address - Country:US
Mailing Address - Phone:540-371-4488
Mailing Address - Fax:
Practice Address - Street 1:29 TALLY HO DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-3308
Practice Address - Country:US
Practice Address - Phone:540-786-8351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020614207RG0300X
VA0017137109363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010315794Medicaid
VA005872308Medicaid
VA005872308Medicaid