Healthcare Provider Details

I. General information

NPI: 1417951377
Provider Name (Legal Business Name): PAUL ANTHONY FRASCELLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W 86TH ST STE 200
INDIANAPOLIS IN
46260-1931
US

IV. Provider business mailing address

2020 W 86TH ST STE 200
INDIANAPOLIS IN
46260-1931
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-5900
  • Fax: 317-872-6439
Mailing address:
  • Phone: 317-871-5900
  • Fax: 317-872-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number02001543
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: