Healthcare Provider Details

I. General information

NPI: 1609862754
Provider Name (Legal Business Name): CARMEN ANTHONY FRATTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WESTSIDE BLVD
BALTIMORE MD
21228-4062
US

IV. Provider business mailing address

407 WESTSIDE BLVD
BALTIMORE MD
21228-4062
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-6741
  • Fax: 410-744-4698
Mailing address:
  • Phone: 410-744-6741
  • Fax: 410-744-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0001789
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: