Provider Demographics
NPI:1033106828
Name:FRATIANNI, CARMEL M (MD)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:M
Last Name:FRATIANNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 W BALTIMORE PIKE STE 3408
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:484-234-5000
Mailing Address - Fax:484-234-5001
Practice Address - Street 1:1098 W BALTIMORE PIKE STE 3408
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:484-234-5000
Practice Address - Fax:484-234-5001
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101823207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35889Medicare UPIN
ILL76276Medicare PIN
IL256510Medicare PIN
IL256510Medicare PIN