Healthcare Provider Details

I. General information

NPI: 1760475966
Provider Name (Legal Business Name): WENDY DOUGLAS FRICKEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DRIVE CAYUGA MEDICAL CTR
ITHACA NY
14850
US

IV. Provider business mailing address

76 DELAWARE AVE
DAMASCUS PA
18415
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4322
  • Fax:
Mailing address:
  • Phone: 570-224-8899
  • Fax: 570-224-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: