MEDICARE: FREDERICK MCELRATH SR.

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1861131500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK MCELRATH SR.

Provider Business Mailing Address
First Line	:	2114 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1725
Country	:	US
Telephone Number	:	216-268-2400
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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