MEDICARE: JOHN A FRACCHIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	120845	NY

General Provider Information

NPI Number	:	1205887759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A FRACCHIA MD

Provider Business Mailing Address
First Line	:	245 E 54TH ST
Second Line	:	2N
City	:	NEW YORK
State	:	NY
Zip	:	10022-4707
Country	:	US
Telephone Number	:	212-570-6800
Fax Number	:	212-734-7425

Provider Business Practice Location Address
First Line	:	245 E 54TH ST
Second Line	:	2N
City	:	NEW YORK
State	:	NY
Zip	:	10022-4707
Country	:	US
Telephone Number	:	212-570-6800
Fax Number	:	212-734-7425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	11/09/2016

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