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General NPI Number Information
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NPI Number | 1356629331
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Entity Type | Organization
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Legal Business Name | THE FROST MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 10 E 6TH AVE SUITE 200
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1784
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Country | US
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Telephone | 610-567-0088
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Fax | 610-567-0881
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Provider Business Mailing Address
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Address Line | 10 E 6TH AVE SUITE 200
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1784
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Country | US
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Telephone | 610-567-0088
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Fax | 610-567-0881
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL FROST
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Credential | M.D.
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Telephone | 610-567-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 467118
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License Number State | PA
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