MEDICARE: FRANK P. FECHNER

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	261QM2500X	Medical Specialty Clinic/Center	219725	MA

General Provider Information

NPI Number	:	1811120066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK P. FECHNER

Provider Business Mailing Address
First Line	:	428 SHREWSBURY ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01604-1661
Country	:	US
Telephone Number	:	508-754-4000
Fax Number	:	508-754-4222

Provider Business Practice Location Address
First Line	:	428 SHREWSBURY ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01604-1661
Country	:	US
Telephone Number	:	508-754-4000
Fax Number	:	508-754-4222

Authorized Official
Title or Position	:	MD
Name	:	FRANK P FECHNER
Credential	:
Telephone Number	:	508-754-4000

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	09/03/2009

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