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General NPI Number Information
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NPI Number | 1831169820
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Entity Type | Individual
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Provider Name | FREDERICK J RESCORLA MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR STE 2500
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-274-4681
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Fax | 317-274-4491
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Provider Business Mailing Address
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Address Line | 705 RILEY HOSPITAL DR STE 2500
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-274-4681
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Fax | 317-274-4491
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 01031794A
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License Number State | IN
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