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General NPI Number Information
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NPI Number | 1518073972
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Entity Type | Individual
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Provider Name | FRANK A DIFAZIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3424 SHELBY RAY CT
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City | CHARLESTON
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State | SC
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Zip | 29414-5838
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Country | US
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Telephone | 843-402-6834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone |
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 87400
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 321517
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 38363
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 038363
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License Number State | CT
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