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General NPI Number Information
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NPI Number | 1205927613
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Entity Type | Individual
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Provider Name | JEFFREY SCOTT FRATTALI PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 10910 LITTLE PATUXENT PKWY STE 205
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City | COLUMBIA
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State | MD
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Zip | 21044-3092
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Country | US
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Telephone | 410-772-0707
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Fax | 410-772-5654
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 209-663-9008
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Fax | 920-684-1439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0002283
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0002283
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License Number State | MD
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