Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25MA02885000 | NJ |
NPI | 1184674160 |
---|---|
Provider Name | Michael A Frattarola |
First Address | Marlton, NJ 08053-4197 |
Second Address | Camden, NJ 08103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C57189 | (02) | NJ |