Healthcare Provider Details

I. General information

NPI: 1053464842
Provider Name (Legal Business Name): MARK ROBERT FRACASSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

2333 ONTARIO RD NW
WASHINGTON DC
20009
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-7008
  • Fax: 202-332-0541
Mailing address:
  • Phone: 202-420-7008
  • Fax: 202-332-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101034665
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD15297
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD68386
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: