Healthcare Provider Details

I. General information

NPI: 1629754379
Provider Name (Legal Business Name): MICHAELA MARIE FRITSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA MARIE MASS

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PENTAGON BLVD STE 400
BEAVERCREEK OH
45431-1705
US

IV. Provider business mailing address

4406 MONTGOMERY RD
NORWOOD OH
45212-3116
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-2873
  • Fax:
Mailing address:
  • Phone: 513-376-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: