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Kevin Dale Frederick

Radiology

Allopathic & Osteopathic Physicians

100 N Academy Ave, M.C. 20-07, Danville, PA 17822-9800

PECOS Enrollment

This provider is enrolled in PECOS as KEVIN FREDERICK.

Based on the most recent information from CMS, provider Kevin Dale Frederick is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1629233572
Provider Type
Individual
Full Name
Frederick, Kevin Dale
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
7/21/2008
Last Updated
6/9/2020

Contact Information

Practice Location

100 N Academy Ave, M.C. 20-07, Danville, PA 17822-9800

(570) 271-6301

Unlisted Fax

Mailing Location

100 N Academy Ave, M.C. 20-07, Danville, PA 17822-9800

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License MD436166 Pennsylvania

Kevin Dale Frederick

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Bachert, Brandon John

Collins, Scotty R.

Delvecchio, Leonard Matthew

Patel, Rasila P.

Froicu, Monica

Pitzen, Joshua Nicholas

Bronov, Oleg E.

Woomert, Cathleen A.

Geisinger Clinic

Conca, Dominick M.