Healthcare Provider Details

I. General information

NPI: 1205286481
Provider Name (Legal Business Name): MICHAEL PATRICK FRITERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MEMORIAL DR
FARRELL PA
16121-1357
US

IV. Provider business mailing address

606 CLOISTERBANE DR
ST JOHNS FL
32259-8239
US

V. Phone/Fax

Practice location:
  • Phone: 724-981-3500
  • Fax:
Mailing address:
  • Phone: 412-726-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS019783
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS18795
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOS019783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: