Healthcare Provider Details

I. General information

NPI: 1164884904
Provider Name (Legal Business Name): FRANK TADDEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MAYSVILLE RD
MOUNT STERLING KY
40353-9767
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-497-4144
  • Fax: 859-498-4137
Mailing address:
  • Phone:
  • Fax: 859-498-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number54396
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008238
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15805
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: