MEDICARE: DOMINIC FRASCA 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	207Q00000X	Family Medicine Physician	0101-051448	VA

General Provider Information

NPI Number	:	1437112869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC FRASCA MD

Provider Business Mailing Address
First Line	:	509 STONEGATE DR
Second Line	:
City	:	BLACKSBURG
State	:	VA
Zip	:	24060-3245
Country	:	US
Telephone Number	:	540-951-1308
Fax Number	:

Provider Business Practice Location Address
First Line	:	0140 MCCOMAS HALL
Second Line	:	VIRGINIA TECH
City	:	BLACKSBURG
State	:	VA
Zip	:	24061-0001
Country	:	US
Telephone Number	:	540-231-6444
Fax Number	:

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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