Individual ProviderFrederick PlaceEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address3300 Gallows Rd, Falls Church, VA 22042-3307(703) 776-3111(888) 898-3291PECOS EnrollmentBased on the most recent information from CMS, provider Frederick Place is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1336190123Provider TypeIndividualFull NamePlace, FrederickCredentialMDGenderMaleSole ProprietorNoEnumeration Date5/15/2006Last Updated7/17/2007Contact InformationPractice LocationPractice Address3300 Gallows Rd, Falls Church, VA 22042-3307Phone(703) 776-3111Fax(800) 536-8431Mailing LocationMailing AddressPO Box 75567, Baltimore, MD 21275-5567Phone(888) 898-3291Fax(800) 536-8431Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense0101231149VirginiaProvider IdentifiersIDDescriptionIssuerID5859956DescriptionMedicaidIssuerUnlistedVirginia