Provider Demographics
NPI:1992784847
Name:VORWALD, FREDERICK U (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:U
Last Name:VORWALD
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 1:650 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:PO BOX 1845
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4353
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-873-4511
Practice Address - Street 1:125 DAYS INN DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6323
Practice Address - Country:US
Practice Address - Phone:704-660-9111
Practice Address - Fax:704-663-4504
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC898510KMedicaid
NC898510KMedicaid
080106978Medicare PIN
NC2214098DMedicare ID - Type Unspecified