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General NPI Number Information
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NPI Number | 1235441999
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Entity Type | Individual
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Provider Name | LARISA BUYANTSEVA FRITZ MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 12/19/2020
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Provider Practice Location Address
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Address Line | 21 WATERFORD DR
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City | MECHANICSBURG
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State | PA
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Zip | 17050
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Country | US
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Telephone | 717-988-9180
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Fax | 717-775-5723
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Provider Business Mailing Address
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Address Line | 21 WATERFORD DR
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City | MECHANICSBURG
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State | PA
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Zip | 17050-8268
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Country | US
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Telephone | 717-988-9180
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Fax | 717-775-5723
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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 | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD463785
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | D0079508
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD463785
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License Number State | PA
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