Healthcare Provider Details

I. General information

NPI: 1093174732
Provider Name (Legal Business Name): NICOLE FRATICELLI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MONUMENT RD STE 290
YORK PA
17403-5073
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-4090
  • Fax: 717-812-4092
Mailing address:
  • Phone: 717-812-4090
  • Fax: 717-812-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberFF0001987
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS021041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: