Healthcare Provider Details

I. General information

NPI: 1063552529
Provider Name (Legal Business Name): FRANK DANIEL MONGIARDO M.D. P.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SUITE 2N
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR SUITE 2N
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-4466
  • Fax: 606-439-1941
Mailing address:
  • Phone: 606-439-4466
  • Fax: 606-439-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4979P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25357
License Number StateKY

VIII. Authorized Official

Name: MR. FRANK DANIEL MONGIARDO
Title or Position: M.D.
Credential: M.D.
Phone: 606-439-4466